Discussing the midwifery scope of practice within the NANDA-I taxonomy.

PURPOSE: To discuss the midwifery scope of practice within the NANDA-I taxonomy. METHODS: Review of the NANDA-I taxonomy followed by critical analysis of the nursing diagnoses (NDs) within the scope of midwifery practice. Search terms were defined. Two authors independently analyzed all diagnoses, and another author validated the results. FINDINGS: Of the 267 NDs in the NANDA-I taxonomy, 39 (14.6%) perceived a relationship with midwifery's scope of practice, and among these, 15 (5.6%) guaranteed greater specificity and accuracy for clinical reasoning. CONCLUSIONS: The suitability of NDs for the broad spectrum of the midwifery scope of practice may need to be completed. Women's responses to life events and health conditions are simultaneously complex and specific, and many NDs in the NANDA-I terminology may be far from fully identified and developed to represent these responses. IMPLICATIONS FOR NURSING PRACTICE: Improvements in NANDA-I diagnosis would contribute to advanced terminology and increased specificity and accuracy of the diagnostic process. This is important in achieving appropriate outcomes and safe and effective interventions for which the nurses and nurse-midwives are accountable. Many NDs would not necessarily be used in any other context since they are specific to midwifery; however, it would help to develop a NANDA-I taxonomy that is more inclusive and comprehensive internationally.

OBJETIVO: Discutir o âmbito da prática de atenção materna dentro da taxonomia da NANDA­I. MÉTODOS: Revisão da taxonomia da NANDA­I com análise crítica dos diagnósticos de enfermagem, no âmbito da prática de atenção materna. Os termos de pesquisa foram definidos. Dois autores analisaram, independentemente, todos os diagnósticos e um outro autor validou os resultados. RESULTADOS: Dos 267 diagnósticos de enfermagem da taxonomia NANDA­I, em 39 (14,6%) percebe­se relação com o âmbito da prática de atenção materna. Além disso, destes 38 diagnósticos incluídos, 15 (5,6%) garantem maior especificidade e acurácia para o raciocínio clínico. CONCLUSÕES: A adequação dos diagnósticos de enfermagem ao amplo espectro da prática de atenção materna pode precisar ser completada. As respostas das mulheres aos acontecimentos de vida e às condições de saúde são, simultaneamente, complexas e específicas e muitos diagnósticos de enfermagem na terminologia da NANDA­I podem não estar totalmente identificados e desenvolvidos para representar essas respostas. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Melhorias nos diagnósticos da NANDA­I contribuiriam para uma terminologia avançada e para o aumento da especificidade e precisão do processo de diagnóstico. Isto é importante para a obtenção de resultados apropriados e intervenções seguras e eficazes, pelas quais os enfermeiros de atenção à saúde materna são responsáveis. Muitos diagnósticos de enfermagem não seriam necessariamente usados em qualquer outro contexto, uma vez que são específicos da atenção materna; no entanto, ajudaria a desenvolver uma taxonomia NANDA­I mais inclusiva e abrangente, a nível internacional.

Risk of chronic kidney disease in 260 patients with lupus nephritis-analysis of a nationwide multicentre cohort with up to 35 years of follow-up.

OBJECTIVES: To compare proliferative (PLN) and membranous (MLN) lupus nephritis (LN) regarding clinical and laboratory presentation and long-term outcomes; To investigate predictors of progression to chronic kidney disease (CKD). METHODS: Multicentre observational study, with retrospective analysis of a prospective cohort, using data from the Rheumatic Diseases Portuguese Registry-Reuma.pt. Patients with biopsy-proven PLN, MLN and mixed LN were included. Cox regression survival analysis was used to investigate predictors of CKD. RESULTS: 260 patients were included. Median follow-up was 8 years (IQR 11; minimum 1, maximum 35 years). MLN patients presented with significantly lower serum creatinine (0.70 (IQR 0.20; minimum 0.50, maximum 1.30) mg/dl vs 0.80 (IQR 0.31; minimum 0.26, maximum 2.60) in PLN, p= 0.003). Proteinuria levels did not differ between groups (p= 0.641). Levels of complement were reduced in PLN but nearly normal in MLN patients, and there were fewer patients with positive anti-dsDNA antibodies in the MLN group (p< 0.001). One year after the beginning of treatment, 62% of the patients achieved EULAR/ERA-EDTA complete response, with further 5% achieving partial response. Patients with lower proteinuria at diagnosis were more likely to achieve a complete renal response at one year, however, proteinuria at diagnosis or at one year did not predict long term CKD. Estimated glomerular filtration rate (eGFR) ≤75 mL/min/1.73 m2 at one year was the strongest predictor of progression to CKD (HR 23 [95% CI 8-62], p< 0.001). Other possible predictors included the use of azathioprine for induction of remission, older age at diagnosis and male sex. CONCLUSION: Proteinuria levels did not predict LN histologic class in our cohort. eGFR cutoff of 75 mL/min/1.73 m2 after one year of treatment was strongly predictive of progression to CKD.

A Functional Bread Fermented with Saccharomyces cerevisiae UFMG A-905 Prevents Allergic Asthma in Mice.

Background: The administration of probiotics has been shown to be beneficial in asthma. The administration of Saccharomyces cerevisiae UFMG A-905 prevented asthma development. Traditionally, probiotics are administered using dairy-based matrices, but other vehicles (e.g., fruit juices, biscuits, candies, and breads) can be used. Objectives: This study aimed to assess the effect of bread fermented with S. cerevisiae UFMG A-905 in asthma prevention. Methods: Three breads were produced: fermented with commercial yeast, fermented with S. cerevisiae UFMG A-905, and fermented with S. cerevisiae UFMG A-905 with the addition of alginate microcapsules containing live S. cerevisiae UFMG A-905. Characterization of the microbial composition of the breads was performed. Male Balb/c mice were sensitized and challenged with ovalbumin. Breads were administered 10 d before the first sensitization and during sensitization and challenge protocol. Yeast fecal count, in vivo airway hyperresponsiveness, and airway and lung inflammation were assessed. Results: In UFMG A-905 bread, there was an increase in yeast number and a decrease in total and lactic acid bacteria. Animals that received S. cerevisiae UFMG A-905 fermented bread with microcapsules had a significant increase in yeast recovery from feces. S. cerevisiae UFMG A-905-fermented breads partially reduced airway inflammation, decreasing eosinophils and IL5 and IL13 concentrations. When adding microcapsules, the bread also diminished airway hyperresponsiveness and increased IL17A concentrations. Conclusions: S. cerevisiae UFMG A-905 was able to generate long-fermentation breads. Microcapsules were a safe and viable way to inoculate the live yeast into food. The administration of breads fermented with S. cerevisiae UFMG A-905 prevented asthma-like characteristics, being more pronounced when the breads contained microcapsules with live yeast.

Posttraumatic growth in women after a childbirth experience: The influence of individual characteristics and intrusive and deliberate rumination.

OBJECTIVE: This study targets women who had a self-defined traumatic childbirth experience to (a) explore the differences between sociodemographic-, obstetric-, and trauma-related variables in relation to the rumination style; (b) determine differences between intrusive and deliberate rumination in relation to posttraumatic growth (PTG) dimensions, and (c) test whether intrusive rumination is associated with deliberate rumination, which in turn is associated with PTG dimensions. METHOD: A cross-sectional study design was employed using a web-based survey method for data collection. In total, 202 women who identified their childbirth experience as traumatic participated in this study. RESULTS: Intrusive rumination and deliberate rumination were positively associated with all dimensions of PTG in women following the traumatic childbirth event. Deliberate rumination fully explained the relationship between intrusive rumination and PTG aspects of relating to others, new opportunities, and personal strength, and partially explained the relationship between intrusive rumination and PTG aspects of spiritual changes and appreciation of life. CONCLUSIONS: The results suggest that deliberate rumination can contribute to explain the occurrence of PTG. These findings could help develop psychosocial interventions to maximize opportunities for deliberate rumination for women with traumatic childbirth experiences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Women's fear of childbirth during pregnancy: A concept analysis.

PURPOSE: To map and analyze the concept of women's fear of childbirth (FOC) during pregnancy and to develop a new nursing diagnosis (ND). METHODS: Concept analysis based on Walker and Avant's methodology. An integrative literature search was conducted in Scopus, Web of Science, and CINAHL Complete databases, including peer-reviewed articles published in English from January 1981 to October 2022. FINDINGS: Thirty-one studies were included in the review. Women's FOC during pregnancy comprises three central categories: attributes, antecedents, and consequences. Nine main characteristics (attributes) are related to one or more of eight prior conditions (antecedents) that have the potential to exert negative or favorable impacts (consequences), depending on whether coping strategies have been a part of a fearful woman's pregnancy. These elements and relationships among them should be viewed as dynamic. CONCLUSIONS: Women's FOC during pregnancy is a subjective, multidimensional, and dynamic concept that benefits prenatal care responses. A conceptual matrix on prenatal care will consider the factors underlying women's FOC and their potential mechanisms, how fearful pregnant women respond, the aspects that shape FOC, and how it influences outcomes when supporting pregnant women with FOC. Therefore, the study findings can be used to inform ways of identifying fearful women or as a basis for interventions to manage fears and enhance the confidence of pregnant women for childbirth. IMPLICATIONS FOR NURSING PRACTICE: The results of this study help nurses, OB nursing practitioners, nurse-midwives, and midwives to identify the condition of women's FOC during pregnancy and guide nursing therapeutic interventions to decrease the negative effects on women's health and well-being. Therefore, there are valuable reasons to propose using "fear of childbirth" as a ND in the class "coping responses" within domain coping/stress tolerance, contributing to refining the NANDA-I taxonomy.

OBJETIVO: Mapear e analisar o conceito de medo do parto em mulheres durante a gravidez e desenvolver um novo diagnóstico de enfermagem. MÉTODOS: Análise de conceito com base na metodologia de Walker e Avant. Foi realizada uma pesquisa integrativa da literatura nas bases de dados Scopus, Web of Science e CINAHL Complete e incluiu artigos revistos por pares, publicados em inglês, de janeiro de 1981 a outubro de 2022. RESULTADOS: Trinta e um estudos foram incluídos na revisão. O medo do parto em mulheres durante a gravidez é composto por três categorias centrais: atributos, antecedentes e consequências. Nove características principais (atributos) estão relacionadas com uma ou mais das oito condições anteriores (antecedentes) que têm o potencial de exercer um impacto negativo ou favorável (consequências), dependendo se estratégias de coping fizeram parte da gravidez de uma mulher com medo. Estes elementos e as relações entre eles devem ser vistos como dinâmicos. CONCLUSÕES: O medo do parto em mulheres durante a gravidez é um conceito subjetivo, multidimensional e dinâmico que beneficia de respostas pelos cuidados pré-natais. Uma matriz conceptual sobre cuidados pré-natais considerará os fatores subjacentes ao medo do parto nas mulheres e os seus potenciais mecanismos, como as mulheres grávidas com medo respondem, os aspetos que moldam o medo do parto, e como influenciam os resultados quando as mulheres grávidas com medo do parto são apoiadas. Portanto, os resultados do estudo podem ser usados para identificar mulheres com medo ou desenvolver intervenções que permitam gerir os medos e aumentar a confiança das mulheres grávidas para o parto. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Os resultados deste estudo ajudarão os enfermeiros de atenção à saúde materna a identificar a condição do medo do parto nas mulheres durante a gravidez e orientar intervenções terapêuticas de enfermagem, no sentido de diminuir os efeitos negativos do medo na saúde e no bem-estar das mulheres. Portanto, há razões relevantes para propor a utilização do "medo do parto" como um diagnóstico de enfermagem na classe "coping responses" do domínio "coping/stress tolerance", contribuindo para o refinamento da taxonomia NANDA-I.

Qualidade de vida das pessoas com cancro da próstata: Um modelo de cuidados de enfermagem / Quality of life of prostate cancer patients: A nursing care model / Calidad de vida de los pacientes con patología oncológica prostática: Un modelo de cuidados de enfermería

Resumo Enquadramento: O cancro representa uma experiência dramática na vida de qualquer pessoa, perturbando a sua homeostasia. Dado o envelhecimento da população e a sobrevivência mais prolongada destes doentes, é essencial melhorar a sua qualidade de vida. Objetivo: Desenvolver e implementar um modelo de acompanhamento em enfermagem centrado nas vulnerabilidades dos doentes com cancro da próstata, a fim de melhorar a sua qualidade de vida. Metodologia: Estudo piloto realizado através da aplicação das escalas QLQ-INFO25 e HADS e de uma entrevista, na consulta de ambulatório de um hospital privado, a seis doentes com cancro da próstata. Resultados: Alterações nas dimensões da qualidade de vida relacionada com a saúde. A implementação do modelo de acompanhamento permitiu concluir que "educação em saúde, autoconfiança e atitude" são aspetos essenciais no trabalho dos enfermeiros com estes doentes. O trabalho direcionado às vulnerabilidades dos doentes melhorou a sua qualidade de vida. Conclusão: O modelo contribui para a promoção da saúde e do bem-estar, prevenção de complicações e aumento da satisfação. O trabalho individualizado da equipa melhora a qualidade de vida destes doentes.

Abstract Background: Cancer constitutes a dramatic life experience, disrupting homeostasis. With population aging and prolonged survival in cancer patients, it is essential to increase their quality of life. Objective: To develop and implement a nursing follow-up model focused on the vulnerabilities of patients with prostate cancer in order to improve their quality of life. Methodology: A pilot study was conducted on six patients with prostate cancer. Data were collected through the application of the QLQ-INFO25 and HADS and interviews in the outpatient consultation of a private hospital. Results: Changes in the dimensions of health-related quality of life. Implementing the follow-up model revealed that "health education, self-confidence, and attitude" are essential aspects of the nurses' work with these patients. Working on patients' vulnerabilities improved their quality of life. Conclusion: The model benefits health promotion, well-being, complication prevention, and increased satisfaction. The team's individualized work improves these patients' quality of life.

Resumen Marco contextual: La enfermedad oncológica representa una experiencia dramática en la vida de cualquier persona, ya que altera la homeostasis. Dado el envejecimiento de la población y la supervivencia más prolongada de estos pacientes, es esencial aumentar su calidad de vida. Objetivo: Desarrollar e implantar un modelo de seguimiento de enfermería centrado en las vulnerabilidades de los pacientes con enfermedad oncológica prostática para mejorar su calidad de vida. Metodología: Se llevó a cabo un estudio piloto en el que se aplicaron las escalas QLQ-INFO25 y HADS, y una entrevista en la consulta externa de un hospital privado a seis pacientes con cáncer de próstata. Resultados: Cambios en las dimensiones de la calidad de vida relacionada con la salud. La implementación del modelo de seguimiento nos permitió concluir que "la educación sanitaria, la autoconfianza y la actitud" son aspectos esenciales del trabajo de los enfermeros con estos pacientes. Trabajar sobre las vulnerabilidades de los pacientes mejoró su calidad de vida. Conclusión: El modelo beneficia la promoción de la salud, el bienestar, la prevención de complicaciones y el aumento de la satisfacción. El trabajo individualizado del equipo mejora la calidad de vida de estos pacientes.

Encapsulation of pomegranate polyphenols by ionic gelation: Strategies for improved retention and controlled release.

This study aimed at producing pectin hydrogel beads by ionic gelation proce to carry pomegranate extract (PE) evaluating approaches to increase its retention and protect the polyphenols from environmental conditions that interfere in the stability and color of these compounds, such as the pH of the medium. Several strategies were tested to reduce the mass transfer and consequently increase its retention. The insertion of a filler (gelatinized starch), the employment of different concentrations from the external environment, the adsorption using blank pectin-starch beads, and the electrostatic coating using chitosan were performed. The release of entrapped compounds over time was employed to evaluate the release pattern of PE in water media. Diffusion coefficients calculated from these experiments were then used to estimate the PE release behavior. The encapsulation efficiency (EE) was significantly improved (42 % to 101 %) when equalizing the concentration of the external medium with that from the beads formulation. Furthermore, the increase in the PE concentration was proportional to the rise in the mechanical strength (MS) of the beads which indicates a modification of internal structure due to the presence of polyphenols. The adsorption was efficient in entrapping the active compound, and despite the high PE content observed for all beads (average value of 2960.26 mg of gallic acid equivalent/100 g sample), they had the lowest diffusion coefficient from the release in water media. Finally, the coating was able to reduce the release rate in most of the tests (DAB uncoated = 0.5 DAB coated), however, during the electrostatic deposition a loss of about 32 % of the phenolic compounds in the chitosan solution was observed which led to a reduced EE. Despite the obtention of retarded release, coating studies need to be improved. Some adjustments in the execution of this technique are necessary so that the losses are reduced and the process becomes viable for the use of beads in food.

Patterns of use of wild food plants by Brazilian local communities: systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis sought to investigate the patterns of use of native wild food plants of Brazil (native and non-cultivated). METHODS: We searched ethnobiological works with food plants in Web of Science, Scielo, Scopus and PubMed using different sets of keywords. Initially, the studies were evaluated based on inclusion criteria (systematic data collection instruments, such as interviews; specification of methods for data collection; and the presence of a species list). The methodological quality of each study was evaluated to define the risk of bias. A total of 20 articles met all criteria and were included in the review. RESULTS: The results showed that there was a predominance of consumption of fruits, followed by leaves and seeds, which together represented 85.8% of the total parts. As for the meta-analysis, there was a predominance of use of plant parts classified as reproductive, non-persistent, non-destructive and parts of woody plants. There was no interference from the type of ecosystem (seasonally dry x moist). The results did not support the seasonality hypothesis. CONCLUSIONS: The concentration of studies in the Northeast, Southeast and South regions of Brazil and in the Atlantic Forest and Caatinga biomes points to the need for a greater effort in terms of quantitative ethnobotanical research in other regions and biomes. The predominance of fruits and plant parts classified as reproductive, non-persistent and non-destructive points to the high potential for implementation of sustainable management strategies aimed at these plants in the country.

Wild food plants of Brazil: a theoretical approach to non-random selection.

Ethnobiological investigations have focused on identifying factors that interfere with the criteria adopted for selection of plants, especially medicinal plants, by different populations, confirming the theory that plant selection is not random. However, regarding wild food plants, little effort has been made to confirm the theory in this context, especially in Brazil. Therefore, this systematic review aimed to contribute to the establishment of theoretical bases of the non-random selection of wild food plants by local populations in Brazil. For this, searches were made in 4 databases, namely, Web of Science, Scielo, Scopus and PubMed, using 8 sets of keywords in English and Portuguese in order to identify wild food plants occurring in Brazil. The steps were: application of inclusion and exclusion criteria, screening of articles, selection of studies based on risk of bias, data treatment and, finally, data analysis. Eighty articles met the inclusion criteria of this review. However, 45 of them were considered to present high risk of bias and thus 35 articles were kept for the identification of overused and underused families. The results were inferred through two different approaches (IDM and Bayesian). Annonaceae, Arecaceae, Basellaceae, Cactaceae, Capparaceae, Caryocaraceae, Myrtaceae, Passifloraceae, Rhamnaceae, Rosaceae, Sapotaceae, Talinaceae, and Typhaceae were considered overused. Eriocaulaceae, Orchidaceae, and Poaceae were considered underused. Therefore, considering that some families are more (or less) used than others, we confirm that the wild food plants occurring in Brazil, known and used by different populations, are not chosen at random.

Effectiveness of perioperative family-centered educational interventions in the anxiety, pain and behaviors of children/adolescents and their parents: Systematic Review Protocol / Eficacia de las intervenciones educativas perioperatorias familiares centradas en la ansiedad, el dolor y las conductas de las personas menores y adolescentes y de sus progenitores: protocolo de revisión sistemática

Introduction: Every year, millions of children and adolescents undergo surgery, 50%-75% of them experience fear and anxiety. Children are particularly susceptible to stress and anxiety surrounding surgery as a result of their cognitive development, previous experiences, and knowledge about healthcare; this leads to additional interventions to prevent and reduce these symptoms. Objective: To evaluate the effectiveness of family-centered educational interventions in the children's and adolescents' anxiety, pain, and behaviors and their parents' anxiety during the perioperative period. Methods: This review will follow the Joanna Briggs Institute guidelines for systematic reviews of effectiveness and will consider those studies (experimental and quasi-experimental) in which perioperative educational interventions have been applied to children and adolescents and their parents; these studies measured children and adolescents' pain, anxiety, and behaviors, as well as their parent's anxiety. An initial search of MEDLINE and CINAHL will be followed by a second search for published and unpublished studies from January 2007 on, available in English, Spanish and Portuguese. After all full texts are retrieved, the methodological quality assessment and data extraction will be independently and critically evaluated by two reviewers, and the data will then be presented in a tabular format. An explanatory synthesis will accompany the results. Whenever possible, a meta-analysis will be performed, and a Grading of Recommendations, Assessment, Development, and Evaluation Summary of Findings will be presented. Expected Results: This review will provide guidance on how family-centred educational interventions can be used as a resource to manage anxiety, pain, and behavior in children, adolescents and their relatives during the perioperative processes.

Introducción: Cada año, millones de personas menores y adolescentes se someten a cirugía, de las cuales entre el 50-75 % experimenta miedo y ansiedad. Las niñas y los niños son particularmente susceptibles al estrés y la ansiedad que rodea a la cirugía, como resultado de su desarrollo cognitivo, experiencias previas y conocimiento de la salud, lo que requiere intervenciones para prevenir y reducir estos síntomas. Objetivo: Esta revisión tiene como objetivo evaluar la efectividad de las intervenciones educativas familiares centradas en la ansiedad, el dolor y los comportamientos de las personas menores y adolescentes y de sus progenitores en el período perioperatorio. Métodos: Esta revisión seguirá las pautas del Instituto Joanna Briggs para revisiones sistemáticas de efectividad y considerará estudios experimentales y cuasiexperimentales en los que las intervenciones educativas perioperatorias para medir el dolor, la ansiedad y los comportamientos en niñas, niños y adolescentes y la ansiedad de sus progenitores. Se ha realizado una búsqueda inicial limitada de MEDLINE y CINAHL. Además, una segunda búsqueda de estudios publicados y no publicados de enero de 2007 disponibles en inglés, español y portugués. Una vez recuperados los textos completos, dos revisores evaluarán críticamente, de forma independiente, la calidad metodológica y la extracción de datos y se presentarán en forma de tabla. Una síntesis narrativa acompañará a los resultados y, si es posible, se realizará un metanálisis y se presentará un Grading of Recommendations, Assessment, Development and Evaluation. Resultados esperados: Esta revisión brindará orientación sobre cómo las intervenciones educativas centradas en la familia pueden usarse como un recurso para controlar la ansiedad, el dolor y el comportamiento en niñas, niños, adolescentes y sus familias en el contexto perioperatorio.

Introdução: Todos os anos, milhões de crianças e adolescentes são submetidos a cirurgias e 50-75% apresentam medo e ansiedade. Crianças/adolescentes são particularmente suscetíveis ao stress e ansiedade em torno da cirurgia devido ao seu desenvolvimento cognitivo, experiências anteriores e conhecimento que possuem sobre os cuidados de saúde, necessitando de intervenções para a prevenção/redução destes sintomas. Objetivo: Avaliar a eficácia de intervenções educacionais centradas na família na ansiedade, dor e comportamentos de crianças/adolescentes e ansiedade dos pais no período perioperatório. Métodos: Esta revisão seguirá a metodologia do Instituto Joanna Briggs para revisões sistemáticas de eficácia e considerará estudos (experimentais e quase-experimentais) em que as intervenções educacionais perioperatórias tenham sido aplicadas a crianças/ adolescentes e seus pais e avaliadas a dor, ansiedade e comportamento em crianças/adolescentes e ansiedade dos pais como resultados. Uma pesquisa inicial limitada de MEDLINE e CINAHL foi realizada. Será seguida por uma segunda busca por estudos publicados e não publicados de janeiro de 2007 disponíveis em inglês, espanhol e português. Após a recuperação dos textos completos, a avaliação da qualidade metodológica e a extração de dados serão avaliadas de forma crítica e independente por dois revisores e apresentadas em forma de tabela. Uma síntese narrativa acompanhará os resultados e, se possível, uma meta-análise será realizada e um resumo das Grading of Recommendations, Assessment, Development and Evaluation apresentado. Resultados esperados: Esta revisão fornecerá orientações sobre como as intervenções educativas centradas na família podem ser utilizadas como um recurso para gestão da ansiedade, dor e comportamento em crianças, adolescentes e suas famílias no contexto perioperatório.

Shear-Wave Elastography Evaluation of Major Salivary Glands in Primary Sjögren's Syndrome.

OBJECTIVES: Salivary glands ultrasonography has recently been shown to be useful in the diagnosis of Primary Sjögren's Syndrome (pSS). Shear-wave elastography (SWE) is a promising tool for the quantitative assessment of tissues stiffness, but studies evaluating its role in pSS diagnosis are limited. This study aimed at investigating the diagnostic performance of SWE in pSS. MATERIALS AND METHODS: Cross-sectional study including patients fulfilling the 2016 ACR/EULAR classification criteria for pSS and healthy subjects. The four major salivary glands were assessed using SGUS. B-mode scans were rated using the Hocevar score, and shear-wave velocity (SWV) values were obtained using SWE. Intraclass-correlation coefficient (ICC) estimates were used to assess reliability. Cut-off values for differentiating pSS patients from healthy subjects were calculated using Receiver-Operating Characteristics (ROC) curves. RESULTS: We included 50 pSS and 25 healthy subjects. Inter-rater reliability of SWE was moderate (ICC=0.64) and intra-rater reliability was moderate to good (ICC= 0.73 to 0.83). Total SWV (2.09 m/s (0.32); p < 0.001), parotid SWV (2.25 m/s (0.40)) and submandibular SWV (1.92 m/s (0.38)) were significantly higher in pSS patients. Total and parotid SWV presented good diagnostic performance for pSS diagnosis (AUROC= 0.80 and 0.81, respectively). The Hocevar score demonstrated excellent diagnostic performance (AUROC= 0.98) and combining it with total SWV did not result in statistically significant improvement (p=0.301). CONCLUSIONS: SWE may contribute to the diagnosis of pSS. Large prospective studies including sicca and secondary SS patients, as well as the standardisation of SWE protocols, are warranted to assess the role of SWE in pSS management.

Midwives' interventions for reducing fear of childbirth in pregnant women: a scoping review.

OBJECTIVE: The objective of this review was to map and analyze midwives' interventions for reducing fear of childbirth in pregnant women. INTRODUCTION: Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy. Over the past few decades, there has been growing research interest in interventions for reducing fear of childbirth in pregnant women. One of the challenges in midwifery care is to provide an appropriate model of care for pregnant women with fear of childbirth. Further research efforts are needed to identify midwives' interventions for reducing fear of childbirth in pregnant women and to examine their characteristics. INCLUSION CRITERIA: This scoping review considered studies that included midwives' interventions for reducing fear of childbirth in pregnant women. Specifically, interventions were led and/or implemented by midwives during the antenatal period, and integrating all possible midwifery practice settings. Quantitative, qualitative, and mixed methods studies were included. This review also considered systematic reviews, text and opinion papers, and conference abstracts. METHODS: The JBI methodology for conducting scoping reviews was used. Published and unpublished literature in English, Portuguese, and Spanish from January 1981 to October 2020 was included. MEDLINE (PubMed), CINAHL Complete, APA PsycINFO, Scopus, Embase, Web of Science, SciELO, MedicLatina, Academic Search Complete, ERIC, Psychology and Behavioral Sciences Collection, and the Cochrane Library databases were searched. Searches for gray literature were also undertaken on the Repositório Científico de Acesso Aberto de Portugal, ProQuest Dissertations and Theses, British Library EThOS, OvidSP Resource Center, Banco de Teses da CAPES, and OpenGrey. A three-step search strategy was followed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist was used. Two independent reviewers extracted the data using a data extraction tool developed specifically for this scoping review. RESULTS: A total of 3704 articles were identified and screened, of which 34 articles were included. The majority of studies had been published in the past 10 years (88%) in Scandinavian countries or Australia (79%). Several midwives' antenatal interventions were found, such as midwife-led team models of care. Midwives played a facilitator role that varied across the included studies. In 20 studies (59%), midwives led and implemented the interventions alone ( n   =  13; 38%) or with the participation of other health professionals ( n   =  7; 21%). In the remaining 14 studies (41%), midwives were part of a multidisciplinary team that included different health professionals (mainly obstetricians and psychologists) who had been involved in delivering interventions alongside midwives or with minor participation from midwives. Counseling ( n   =  12; 35%) and psychoeducation ( n   =  8; 24%) were the most common midwife interventions for reducing fear of childbirth in pregnant women. CONCLUSIONS: Midwives working across their full scope of practice play a pivotal role in reducing fear of childbirth, which may explain the variety of midwives' antenatal interventions. Reducing fear of childbirth in pregnant women and promoting normal childbirth as a positive experience are key features of midwives' interventions, which should include women's empowerment measures. Evidence-based midwife-led intervention programs for pregnant women with fear of childbirth should be designed and tested to improve clinical practice as well as women's reproductive outcomes and perinatal experiences.

The porosity of carbohydrate-based spray-dried microparticles containing limonene stabilized by pea protein: Correlation between porosity and oxidative stability.

In this study, the effects of different concentrations of pea protein concentrate (PPC) in the physical properties, porosity features, and oxidative stability of maltodextrin-based spray-dried microparticles containing orange essential oil (OEO, rich in limonene) were evaluated. The use of PPC resulted in spray-dried microparticles with encapsulation efficiencies of about 99 wt%, without visible pores, and relatively high glass transition temperature (66,4 °C) at Aw âˆ¼ 0.3. The nitrogen adsorption and positron annihilation lifetime spectroscopy measurements showed that the increase of PPC concentration from 2.4 to 4.8 wt% (g of PPC/100 g of emulsion) did not affect the porosity features of the microparticles. These results were confirmed by the profiles of OEO retention and limonene oxide production, which were similar for both samples throughout four weeks of storage. Based on these results, we verified that the lower amount of PPC we tested can effectively protect the OEO during storage, showing that a relatively cheaper orange flavor powder can be produced using less protein.

Patterns of Parental Reactions to Their Children's Negative Emotions: A Cluster Analysis with a Clinical Sample.

Parents' emotion socialization practices are an important source of influence in the development of children's emotional competencies This study examined parental reactions to child negative emotions in a clinical sample using a cluster analysis approach and explored the associations between clusters of parents' reactions and children's and parents' adjustment. The sample comprised 80 parents of Portuguese children (aged 3-13 years) attending a child and adolescent psychiatry unit. Measures to assess parental reactions to children's negative emotions, parents' psychopathological symptoms, parents' emotion dysregulation, and children's adjustment were administered to parents. Model-based cluster analysis resulted in three clusters: low unsupportive, high supportive, and inconsistent reactions clusters. These clusters differed significantly in terms of parents' psychopathological symptoms, emotion dysregulation, and children's adjustment. A pattern characterized by high supportive reactions to the child's emotions was associated with higher levels of children's adjustment. On the other hand, an inconsistent reactions pattern was associated with the worst indicators of children's adjustment and parental emotion dysregulation. These results suggest the importance of supporting parents of children with emotional and behavioural problems so that they can be more responsive to their children's emotional manifestations.

Predictors of hospitalization in patients with systemic lupus erythematosus: a 10-year cohort study.

INTRODUCTION/OBJECTIVES: Recognising systemic lupus erythematosus (SLE) patients at higher risk for hospitalization, aiming at developing tailored management strategies, may help minimize admissions and improve long-term health outcomes. Our study aimed to identify predictors for hospitalization in patients with SLE. METHOD: Cohort study of SLE patients followed in a referral centre. All hospitalizations from study baseline up to 120 months were identified, and the primary indication for admission was categorized as follows: (1) SLE disease activity; (2); infection; and (3) other conditions. Demographic, clinical, and laboratory parameters at baseline were sought as predictors of hospitalization for (i) any cause, (ii) disease activity, and (iii) infection using survival analysis with Kaplan-Meier curves and log-rank tests. Potential predictors were further tested using multivariate Cox proportional hazards regression models. RESULTS: We included 398 patients (median follow-up: 120 months). The incidence rate of hospitalization was 17.7 per 100 patient-years. The most frequent indications for hospitalization were SLE disease activity (29.4%) and infection (23.4%). In multivariate analysis, male gender, age > 50 years, antiphospholipid antibodies positivity (aPL), SLEDAI-2 K > 5, organ damage, and prednisone daily dose (PDN) predicted hospitalization for any cause. SLEDAI-2 K > 5, aPL, PDN, and IS medication predicted hospitalization for active SLE. Male gender, prior biopsy-proven lupus nephritis, aPL, organ damage, and ongoing treatment with high-risk IS predicted hospitalization for infection. Treatment with antimalarials was associated with a lower risk of hospitalization for any cause and for infection. CONCLUSIONS: Positive aPL identifies SLE patients presenting a higher risk of hospitalization, while medication with antimalarials was associated with a lower risk. Key Points • Positive aPL is predictive of hospitalization for any medical condition, disease activity, and infection • Organ damage is predictive of hospitalization for any condition and infection • Antimalarials are predictive of a lower risk of hospitalization for any condition and infection.

Targeting the underlying pathophysiology in X-linked hypophosphatemic rickets in adults.

X-linked hypophosphatemic rickets (XLHR) is a life-long phosphate waste disorder that presents in early childhood with lower limb deformities, stunted growth, and bone and joint pain. In adults, osteomalacia and fractures may develop, aggravating bone and joint pain, stiffness, and disability. A 50-year-old woman with XLHR was referred to Rheumatology for incapacitating pain in her left lower limb with gait impairment. A pseudofracture was identified in the radiography of long bones, and secondary hyperparathyroidism was also observed. Treatment was optimized, and marked clinical improvement occurred. The authors review and discuss the underlying pathophysiology of this disease and its adequate management.

Flavoring properties that affect the retention of volatile components during encapsulation process.

Flavorings are widely used in food and beverage industries and spray drying is the most cost-effective encapsulation technique to deliver stable products. Generally, the same slurry is used to encapsulate both hydrophilic and hydrophobic flavors which led sometimes to lower retention. The same slurry formulation composed by Modified Starch and Maltodextrin 20DE was loaded with 35% of two different flavorings (orange and passion fruit) and, spray dried under the same conditions. The flavorings selected had different octanol/water partition coefficients and their composition affected the emulsion stability. Orange flavoring presented clearly better emulsion stability than passion fruit flavoring, confirmed by size distribution and Turbiscan Stability Index (TSI orange ≪ TSI passion fruit). A key learning from this work is that the best infeed emulsion achieved by the most hydrophobic flavoring, presented the lowest droplet size and yielded in final bigger particle size and the best encapsulation efficiency result (>92%).

Prospection of the use of encapsulation in food packaging.

Food safety and extended shelf life linked to convenience were the major reasons for the development of the packaging field. However, advances in material science and the widespread encapsulation technologies are allowing the establishment of new concepts for packages, such as intelligent and active packages. Particulate systems have been developed in recent years for the most diverse area with several purposes that can be employed to improve packaging performance mainly focusing on the modification of barrier properties. This review analyzes the recent developments using encapsulation in food packaging and the main concepts about mass transfer evolved in the functionality of these packages, as well as discusses the research challenges faced by the food packaging sector.