Spatiotemporal Landscape of Kidney Tubular Responses to Glomerular Proteinuria.

BACKGROUND: Large increases in glomerular protein filtration induce major changes in body homeostasis and increase risk of kidney functional decline and cardiovascular disease. We investigated how elevated protein exposure modifies the landscape of tubular function along the entire nephron, to understand the cellular changes that mediate these important clinical phenomena. METHODS: We conducted single nuclei RNA sequencing, functional intravital imaging, and antibody staining to spatially map transport processes along the mouse kidney tubule. We then delineated how these were altered in a transgenic mouse model of inducible glomerular proteinuria (POD-ATTAC) at 7 and 28 days. RESULTS: Glomerular proteinuria activated large-scale and pleotropic changes in gene expression in all major nephron sections. Extension of protein uptake from early (S1) to later (S2) parts of the proximal tubule initially triggered dramatic expansion of a hybrid S1/2 population, followed by injury and failed repair, with the cumulative effect of loss of canonical S2 functions. Proteinuria also induced acute injury in S3. Meanwhile, overflow of luminal proteins to the distal tubule caused transcriptional convergence between specialized regions and generalized dedifferentiation. CONCLUSIONS: Proteinuria modulated cell signaling in tubular epithelia and causes distinct patterns of remodeling and injury in a segment specific manner.

Propolis Protects GC-1spg Spermatogonial Cells against Tert-Butyl Hydroperoxide-Induced Oxidative Damage.

Propolis is a natural resin produced by honeybees with plenty of pharmacologic properties, including antioxidant activity. Oxidative stress disrupts germ cell development and sperm function, with demonstrated harmful effects on male reproduction. Several natural antioxidants have been shown to reduce oxidative damage and increase sperm fertility potential; however, little is known about the effects of propolis. This work evaluated the role of propolis in protecting spermatogonial cells from oxidative damage. Propolis' phytochemical composition and antioxidant potential were determined, and mouse GC-1spg spermatogonial cells were treated with 0.1-500 µg/mL propolis (12-48 h) in the presence or absence of an oxidant stimulus (tert-butyl hydroperoxide, TBHP, 0.005-3.6 µg/mL, 12 h). Cytotoxicity was assessed by MTT assays and proliferation by Ki-67 immunocytochemistry. Apoptosis, reactive oxygen species (ROS), and antioxidant defenses were evaluated colorimetrically. Propolis presented high phenolic and flavonoid content and moderate antioxidant activity, increasing the viability of GC-1spg cells and counteracting TBHP's effects on viability and proliferation. Additionally, propolis reduced ROS levels in GC-1spg, regardless of the presence of TBHP. Propolis decreased caspase-3 and increased glutathione peroxidase activity in TBHP-treated GC-1spg cells. The present study shows the protective action of propolis against oxidative damage in spermatogonia, opening the possibility of exploiting its benefits to male fertility.

The Value of Implementing a Digital Approach in the Obstructive Sleep Apnoea Patient Pathway: A Spanish Example.

Introduction: Continuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnoea (OSA). However, non-adherence is common and costly. The COVID-19 pandemic required the use of novel solutions to ensure service provision and quality of care. This retrospective analysis determined the impact and value of a digital versus standard pathway for the management of OSA in Spain. Methods: A time-driven activity-based costing approach was applied to OSA management over 1 year using a standard or digital pathway. The standard pathway included face-to-face appointments at the time of diagnosis, then after 1-3 months and every 6 months thereafter. The digital pathway had fewer face-to-face appointments and utilised telemonitoring. A cost analysis was performed to determine the per-patient cost per healthcare professional (HCP) for a digital pathway for therapy implementation and follow-up compared with the standard pathway. Results: Compared with the standard pathway, the digital pathway decreased the waiting list time from 18 to 2 months, the overall pathway time from 12 to 6 months, HCP cost per patient from €95 to €85, and number of hospital appointments per patient from 6 to 3.1. Furthermore, CPAP device usage improved from 5.7 to 6.3 h/night and the proportion of individuals defined as adherent increased from 79% to 91%. Conclusions: Implementation of digital processes using available technology reduced HCP time and costs, and improved adherence to CPAP in people with OSA. Greater utilisation of a digital pathway could improve access to therapy, allow personalised patient management, and facilitate better clinical outcomes.

Introducción: La presión positiva continua en la vía aérea (CPAP) es el tratamiento de referencia para la apnea obstructiva del sueño (AOS). Sin embargo, su incumplimiento es frecuente y costoso. La pandemia de COVID-19 requirió el uso de soluciones novedosas para garantizar la prestación de servicios y la calidad de la atención. Este análisis retrospectivo determinó el impacto y el valor de un pathway digital frente a un pathway estándar para el manejo de la AOS en España. Métodos: Se aplicó el Time-DrivenActivityBasedCosting al tratamiento de la AOS durante 1 año utilizando el pathway estándar o digital. El pathway estándar incluía citas presenciales en el momento del diagnóstico, después de 1 a 3 meses y posteriormente cada 6 meses. el pathway digital tenía menos citas presenciales y utilizaba la telemonitorización. Se realizó un análisis de costes para determinar el coste por paciente y profesional sanitario (HCP) del pathway digital para la implementación y el seguimiento de la terapia en comparación con el pathway estándar. Resultados: En comparación con el pathway estándar, el pathway digital redujo el tiempo de la lista de espera de 18 a 2 meses, el tiempo total del pathway del paciente de 12 a 6 meses, el coste del HCP por paciente de 95 a 85 euros, y el número de citas hospitalarias por paciente de 6 a 3,1. Además, el uso del dispositivo de CPAP mejoró de 5,7 a 6,3 h/noche y la proporción de pacientes definidos como adherentes aumentó del 79% al 91%. Conclusiones: La implementación de procesos digitales utilizando la tecnología disponible redujo el tiempo y los costes del HCP y mejoró la adherencia a la CPAP en personas con AOS. Una mayor utilización de un pathway digital podría mejorar el acceso a la terapia, permitir una gestión personalizada del paciente y facilitar mejores resultados clínicos.

Doença Celíaca: Desvelando Histórias / Celiac Disease: Unveiling Stories / Enfermedad Celíaca: Desvelando Historias

Objetivo: explorar o impacto da doença celíaca no bem-estar e no desenvolvimento de crianças, conforme percebido por suas mães, participantes do grupo "Criança Celíaca" no Facebook. Método: Estudo qualitativo, utilizando o método de história oral. A pesquisa centraliza a questão: Como a doença celíaca influencia a qualidade de vida e a saúde durante o crescimento e desenvolvimento infantil? Seis mães foram escolhidas com base em critérios de inclusão específicos e concordaram em participar do estudo. Os dados foram coletados através de entrevistas gravadas no Zoom e analisados por meio de transcrição, agrupamento e categorização dos depoimentos. Resultados:Os achados são divididos em sete categorias: experiências de crianças com doença celíaca; impacto na qualidade de vida, crescimento e desenvolvimento; interações em eventos sociais; experiências escolares; emoções diante da doença; e necessidades das famílias afetadas. Conclusão: O estudo revela a necessidade de maior envolvimento dos profissionais de enfermagem neste campo, enfatizando a importância do papel ativo dos pais na garantia da qualidade de vida de crianças celíacas

Objective: to explore the impact of celiac disease on the well-being and development of children as perceived by their mothers, members of the "CeliacChild" group on Facebook. Method:This qualitative study, employing oral history methodology. The research focuses on the question: How does celiac disease affect the quality of life and health during childhood growth and development? Six mothers were selected based on specific inclusion criteria and agreed to participate in the study. Data were collected through interviews recorded on Zoom and analyzed through transcription, grouping, and categorization of the testimonies. Results:The findings are divided into seven categories: experiences of children with celiac disease; impact on quality of life, growth, and development; interactions at social events; school experiences; emotions in the face of the disease; and the needs of affected families. Conclusion:The study highlights the need for greater involvement of nursing professionals in this field, emphasizing the importance of parents' active role in ensuring the quality of life of children with celiac disease

Objetivo: explorar el impacto de la enfermedad celíaca en el bienestar y desarrollo de los niños, según lo percibido por sus madres, integrantes del grupo "Niño Celíaco" en Facebook. Método:Este estudio cualitativo, utilizando el método de historia oral. La investigación se centra en la pregunta: ¿Cómo afecta la enfermedad celíaca a la calidad de vida y la salud durante el crecimiento y desarrollo infantil? Se seleccionaron seis madres basadas en criterios específicos de inclusión y acordaron participar en el estudio. Los datos se recopilaron a través de entrevistas grabadas en Zoom y se analizaron mediante transcripción, agrupación y categorización de los testimonios. Resultados:Los hallazgos se dividen en siete categorías: experiencias de niños con enfermedad celíaca; impacto en la calidad de vida, crecimiento y desarrollo; interacciones en eventos sociales; experiencias escolares; emociones frente a la enfermedad; y las necesidades de las familias afectadas. Conclusión:El estudio resalta la necesidad de una mayorimplicación de los profesionales de enfermería en este campo, enfatizando la importancia del rol activo de los padres en garantizar la calidad de vida de los niños celíacos.

Subcentimetric Papillary Thyroid Carcinoma: Does the Diagnosis Kind Impact Prognosis?

INTRODUCTION: Subcentimetric papillary thyroid carcinoma (SPTC) (papillary thyroid carcinoma with less than 10 mm in size) usually presents an excellent prognosis, with few aggressive reported cases. Given the globally increased incidence of SPTC, physicians are struggling with the need to identify prognostic factors to stratify SPTC. The aim was to compare clinicopathological variables and prognosis between clinically and incidentally diagnosed SPTC. Materials and methodsː This is a retrospective observational study on patients with SPTC who underwent thyroidectomy between 2002 and 2015. Two groups were considered: G1 (n=60 (61.9%)), clinical diagnosis (Bethesda III-VI cytology in the thyroid tumor/in cervical lymphadenopathies) and G2 (n=37 (38.1%)), incidental diagnosis (thyroidectomy for benign thyroid pathology). The histological material was reviewed, and molecular analysis of the BRAF, RAS, and TERT promoter (TERTp) genes was performed. Resultsː Ninety-seven individuals were included, 60 (61.9%) of which were from G1, with a predominance of female sex (n=83 (85.6%)). Individuals of G1 were younger (53.0±14.2 versus 59.3±13.9 years; p=0.035), were more frequently treated with 131-iodine (39.2% versus 13.4%; p=0.007), had the largest diameter (8 (p25-p75: 7-9) versus 5 (p25-p75: 4-6.5) mm; p<0.001), and higher frequency of minimal extracapsular invasion (45% versus 24.3%; p=0.041). Increased tumor size was the only independent predictor of a clinical diagnosis (p<0.001). Conclusionsː Clinically and incidentally diagnosed SPTC showed excellent medium- to long-term prognosis. A larger SPTC was more likely a driver of clinical detection than a marker of tumor aggressiveness, but caution should be taken as contradictory data persists.

Anxiety and depression among nursing students during the COVID-19 lockdown: A cross-sectional correlational study.

AIMS AND OBJECTIVES: To determine the prevalence and levels of anxiety and depression symptoms among nursing students during the coronavirus lockdown, and to examine factors associated with higher levels of anxiety and depression on this population. BACKGROUND: Nursing students deal with diverse stressors during their university lives. Confinement measures during COVID-19 outbreak may have influenced students' mental health and well-being. Anxiety and depression are common among nursing students due to different factors. Evidence relating to anxiety and depression in nursing student population during SARS-CoV-2 pandemic is limited. DESIGN: A cross-sectional descriptive co-relational study during the lockdown due to the coronavirus outbreak in Spain was conducted. METHODS: An online questionnaire was developed by using google forms. Sociodemographic characteristics form, and the Spanish version of the Hospital Anxiety and Depression Scale (HADS) were used. Spanish nursing students across the country were enrolled. Data collection was performed between 4 April 2020 and 21 April 2020. A multivariate analysis was performed to determine the association between sociodemographic variables, COVID-19 and HADS scores. RESULTS: 1319 participants were enrolled. The sample was formed by 87.1% female students with a mean age of 22 years (SD ± 5.677). We found a mean score of 8.47 ± 4.104 on Scale HADS-Anxiety and 6.80 ± 2.988 on HADS-Depression. 31.6% students presented abnormal scores of anxiety symptoms, and only 11.4% participants revealed abnormal scores on HADS-Depression. CONCLUSIONS: The reported prevalence of anxiety and depression symptoms on nursing students during the COVID-19 lockdown is 56.4% and 38.2%, respectively. 43.6% of the sample scored normal anxiety levels, and 61.8% obtained normal depression levels. Higher anxiety and depression levels were statistically associated with being a first-year student, being a smoker, feeling fear, feeling stress and having any close family member infected. RELEVANCE TO CLINICAL PRACTICE: These data should be valuable for detection and for further treatment decision of this disorders at the initial stage and could be important to prevent further damages to mental health and promote physical, psychological and well-being among this population.

Gestação na adolescência: o desvelar de uma vivência / Teenage pregnancy: unveiling an experience / Embarazo en la adolescencia: la revelación de una experiência

Objetivo: analisar a experiência vivenciada na atenção básica por adolescentes grávidas durante o pré-natal em uma Unidade de Saúde de Ceilândia ­DF. Método:O estudo usou a abordagem qualitativa e o método fenomenológico. A coleta dos dados foi por meio de entrevista direcionada a adolescentes previamente selecionadas mediante adequação aos critérios de inclusão. Foram resguardados o sigilo, a confidencialidade e a fidedignidade dos dados coletados. Resultados:Os dados finais estão apresentados em 6 categorias. Trouxe à evidência de que a gravidez na adolescência ainda é um problema que acomete a identidade em formação de adolescentes e que a falta de adesão aos programas de promoção à saúde por parte deste público ainda existe, necessitando assim de olhar mais apurado e capacitado para atender as necessidades em saúde desta população. Conclusão:o atendimento nessa circunstância demanda cuidados, com isso, profissionais de saúde capacitados devem estar associados a essa situação, de forma que busquem estabelecer vínculos com a adolescente e por meio de uma reflexão com ela, seu companheiro e familiares, tentem encontrar estratégias que possibilitem a minimização de problemas.

Objective:Objective: to analyze the experience lived in primary care by pregnant adolescents during prenatal care at a Health Unit in Ceilândia, Brasília, Brazil. Method:The study used a qualitative approach and the phenomenological method. Datacollection was done through interviews with previously selected adolescents who met the inclusion criteria. Confidentiality and data accuracy were ensured. Results:The final data are presented in 6 categories. It brought to light that adolescent pregnancy is still a problem that affects the forming identity of adolescents and that the lack of adherence to health promotion programs by this group still exists, requiring a more specialized and capable approach to address the health needs of this population. Conclusion: Care in this circumstance demands special attention, therefore, trained healthcare professionals should be involved in this situation, seeking to establish bonds with the adolescent and, through reflection with her, her partner, and family members, find strategies to minimize problems.

Objetivo:analizar la experiencia vivida en la atención primaria por adolescentes embarazadas durante el período prenatal en una Unidad de Salud en Ceilândia, Brasilia, Brasil. Método:El estudio utilizó un enfoque cualitativo y el método fenomenológico. La recopilación de datos se realizó a través de entrevistas dirigidas a adolescentes previamente seleccionadas que cumplían con los criterios de inclusión. Se garantizó la confidencialidad y la veracidad de los datos recopilados. Resultados:Los datos finales se presentan en 6 categorías. Se evidenció que el embarazo en la adolescencia sigue siendo un problema que afecta la identidad en formación de los adolescentes y que la falta de adhesión a los programas de promoción de la salud por parte de este grupo todavía existe, lo que requiere una mirada más especializada y capacitada para abordar las necesidades de salud de esta población. Conclusión:La atención en esta circunstancia requiere cuidados especiales, por lo tanto, profesionales de la salud capacitados deben estar involucrados en esta situación, buscando establecer vínculos con la adolescente y, a través de la reflexión con ella, su pareja y familiares, encontrar estrategias que permitan minimizar los problemas.

Atividade física: a importância dessa pratica no envelhecimento / Physical activity: the importance of this practice in aging / Actividad física: la importancia de esta práctica en el envejecimiento

Objetivo: descrever a importância da atividade física no envelhecimento. Método: abordagem qualitativa e o método de revisão bibliográfica integrativa. A coleta dos dados deu-se em literatura nacional indexada no banco de dados da Scielo. Foram analisados 16 artigos que atenderam aos critérios de inclusão previamente estabelecidos. Resultados: evidenciou-se que a realização de atividade física, sem dúvida age diretamente na esfera biológica do envelhecimento, trazendo benefícios aos sistemas que se comprometem na terceira idade, dentre esses se podem citar o controle da pressão arterial, a melhora da capacidade cardiovascular, respiratória, amplitude da mobilidade, menor risco de doenças, e a prevenção de alguns tipos de câncer. Conclusão: O enfermeiro da atenção básica pode se atribuir de várias metodologias de trabalho, como a formação de grupos, onde ele, articulando-se com a equipe multiprofissional, pode desenvolver tanto para os cuidadores quanto para os idosos, ações reflexivas e motivadoras, que os possibilite perceberem o envelhecimento como um processo benigno e não patológico.

Objective: To describe the importance of physical activity in aging. Method: Qualitative approach and the integrative literature review method. Data collection took place in national literature indexed in the Scielo database. 16 articles that met the previously established inclusion criteria were analyzed. Results: It was evidenced that the practice of physical activity undoubtedly acts directly on the biological sphere of aging, bringing benefits to the systems that are compromised in old age, among these can be mentioned the control of blood pressure, improvement of cardiovascular and respiratory capacity, mobility, lower risk of disease, and the prevention of some types of cancer. Conclusion: The basic care nurse can assume various work methodologies, such as the formation of groups, where he or she, working together with the multidisciplinary team, can develop both for carers and the elderly, reflective and motivating actions that enable them to perceive aging as a benign and non-pathological process.

Objetivo: Describir la importancia de la actividad física en el envejecimiento. Método: Se utilizó un enfoque cualitativo y un método de revisión bibliográfica integrador. La recolección de datos se realizó en la literatura nacional indexada en la base de datos de SciELO. Se analizaron 16 artículos que cumplieron con los criterios de inclusión previamente establecidos. Resultados: Se evidenció que la realización de actividad física actúa directamente en la esfera biológica del envejecimiento, trayendo beneficios a los sistemas comprometidos en la tercera edad. Entre ellos, se puede mencionar el control de la presión arterial, la mejora de la capacidad cardiovascular, la respiración, la amplitud de movilidad, un menor riesgo de enfermedades y la prevención de algunos tipos de cáncer. Conclusión: El enfermero de atención primaria puede utilizar diversas metodologías de trabajo, como la formación de grupos, en conjunto con el equipo multidisciplinario, para desarrollar acciones reflexivas y motivadoras para los cuidadores y los ancianos, permitiéndoles percibir el envejecimiento como un proceso benigno en lugar de patológico.

Extracapsular Cervical Hematoma After Thyroid Fine-Needle Aspiration Cytology.

Fine-needle aspiration cytology (FNAC) is a safe and well-tolerated procedure with high sensitivity and specificity. Serious complications, such as large hematomas, are very rare and should be promptly identified. We present an unusual case of a 71-year-old woman with a massive cervical hematoma that developed near the thyroid capsule after the FNAC of a nodule. CT showed a hematoma measuring 38 x 34 mm, causing deviation of the laryngotracheal axis. The patient was admitted to the intensive care unit for intubation and surgical drainage. This case illustrates that FNAC, despite being considered a safe procedure with infrequent complications, carries the risk of acute life-threatening events that should be taken into account.

Multiple Bone Fractures in a Patient With Difficult-to-Treat Cushing's Disease.

Osteoporosis at a young age should prompt clinicians to search for secondary causes, namely endogenous Cushing's syndrome.We report a case of a 33-year-old male with a history of spontaneous fracture of the 12th thoracic vertebra and florid features of Cushing's syndrome. The physical exam evidenced moon face, facial plethora, muscle atrophy of the upper and lower limbs, and accumulation of abdominal fat. Bone mineral density revealed osteoporosis in the lumbar spine and in the femoral neck. Scintigraphy showed bone fractures in several costal arches, dorsal columns, and sternum. Hypercortisolism was confirmed by blood work. Serum cortisol, adrenocorticotropic hormone and corticotropin (ACTH), and 24-hour urine cortisol values were elevated. Imaging with MRI sellar region was normal and bilateral catheterization of inferior petrosal sinuses was positive. The patient underwent transsphenoidal pituitary surgery (TPS) and a lesion in the right side of the pituitary was identified and resected. Postoperatively, the patient did not meet the remission criteria and we decided to initiate treatment with ketoconazole alongside pituitary radiotherapy. After two years of surgery, the patient presented with recurrent bone fractures, height loss (25 cm), intense fatigue, and difficulty walking without assistance. Due to severe disease, we performed bilateral adrenalectomy, which was essential to control hypercortisolism and improve the patient's quality of life.

Ovarian Hemangioma With Stromal Luteinization.

Ovarian hemangiomas are generally asymptomatic. However, associated stromal luteinization, reported in some cases, may lead to the development of hyperandrogenic syndrome. We report the case of a 61-year-old female referred to the endocrinology outpatient clinic for hirsutism, hair loss, and deepening of the voice tone. The investigation showed high serum testosterone and normal dehydroepiandrosterone sulfate (DHEAS). Normal ovaries were observed in the initial transvaginal ultrasound, but an abdominal-pelvic nuclear magnetic resonance imaging (MRI) identified a solid mass in the right ovary. The patient underwent surgery, and pathological examination revealed a capillary-type ovarian hemangioma with stromal luteinization. After the surgery, clinical and analytical response was very favorable.

Glycaemic control during the COVID-19 pandemic: A catastrophe or a sign of hope for the person with type 1 Diabetes Mellitus?

INTRODUCTION: In a person with type 1 diabetes, any change concerning daily routine may lead to changes in glycaemic control. This study aimed to evaluate the impact of work and lockdown on glycaemic control in adults with type 1 diabetes. MATERIAL AND METHODS: A retrospective cohort was stratified into three activity groups (g1-students/telework/laid-off; g2-unemployed/retired; g3-work without lockdown). Continuous and categorical variations (reductions≥0.4%) in glycated haemoglobin were obtained in 2020 (t3:December/2019-March/2020; t4:April/2020-July/2020) and in homologous periods of 2019. Intragroup comparisons between years and intergroups in the same year were made. Regression models were developed to predict the variation of glycated haemoglobin in 2020. RESULTS: 241 participants were included, with a significant reduction between t4 and t3 (vs. t2 and t1) in g1 (p<0.001) and g2 (p=0.025) and in 2020 in g1 (vs. g2, p<0.001; vs. g3, p<0.001). Only g1 presented superiority in the reduction ≥0.4% in glycated haemoglobin in 2020 (vs. 2019, p<0.001; vs. g2, p<0.001; vs. g3, p<0.001). The insulin regimens were comparable and the development of hypoglycaemia was found to be superimposed between t3 and t4, except for g1, which was higher at t3 (p=0.029). G1 correlated with continuous reductions (vs. g2, p=0.001; vs. g3, p<0.001) and ≥0.4% in glycated haemoglobin in 2020 (vs. g2, OR 3.6, p<0.001; vs. g3, OR 12.7, p<0.001), regardless of the age and duration of type 1 diabetes. CONCLUSIONS: A more stable and better glycaemic control was observed in participants who transitioned from face-to-face work to total lockdown.

Emotional Burden among Pharmacists and Pharmacy Technicians during the COVID-19 Lockdown: A Cross Sectional Study.

This study aims to investigate the prevalence of depression and anxiety symptoms among Spanish community pharmacists and pharmacy technicians during the coronavirus disease 2019 (COVID-19) lockdown. A descriptive cross-sectional quantitative study was designed. An online survey was administered to participants from 4 to 21 April 2020 using a questionnaire assessing sociodemographic information and the Spanish version of the Hospital Anxiety and Depression Scale (HADS). Informed consent to participate was requested. Participants comprised 1162 pharmacy staff from Spain with an average age of 39.15 ± 9.718, from 20 to 65 years old, of whom 83% were women, and 50.6% were married. More than half of the participants expressed symptoms of depression (62.7%) and anxiety (70.9%). An important prevalence of anxiety and depression symptoms has been detected among Spanish pharmacists and pharmacy technicians during the COVID-19 lockdown. Being a woman, smoking, feeling fear, feeling stress and believing that pharmacists/pharmacy technicians are very exposed to COVID-19 seem to be associated with higher HADS scores.

Insipid diabetes and vaginal ulcers: evidence for the diagnosis of Langerhans cell hypophysitis.

Not required for Clinical Vignette.

Impact of pharmacological treatment of gestational diabetes on the mode of delivery and birth weight: a nationwide population-based study on a subset of singleton pregnant Portuguese women.

AIMS: To access the impact of increasing use of metformin on cesarean section and large for gestational age rates, when compared to insulin. METHODS: A retrospective observational study was developed using data from the Portuguese National Registry, between 2011 and 2019, of 5038 Portuguese women with single pregnancies and gestational diabetes treated with metformin and/or insulin. Three groups were defined according to the therapeutic regimen adopted: g1-insulin in monotherapy (n = 3027[60.1%]); g2-metformin in monotherapy (n = 1366[27.1%]); g3-metformin and insulin (n = 645[12.8%]). Multivariate analysis was adjusted for statistically significant covariates. RESULTS: The cesarean section rate in g1 was similar to g2 (g1:36.9% vs. g2:37%, p = 0.982), although g3 was associated with cesarean delivery (g3:43.6% vs. g1:36.9%, p = 0.005; g3:43.6% vs. g1:37.0%, p = 0.002), with no differences reported in the multivariate analysis adjusted for year of delivery and pregestational body mass index. A delivery of a large for gestational age newborn was less frequently observed in g2 than in g1 (g2:4.1% vs. g1:5.4%, p = 0.044) and in g3 (g2:4.1% vs. g3:9.1%, p < 0.001), and in g1, when compared to g3 (g1:5.4% vs. g3:9.1%, p < 0.001). In the multivariate analysis, g2 showed lower odds of delivering a large for gestational age newborn, compared to g1 (ß = -0.511, OR = 0.596, CI95% = 0.428-0.832, p < 0.001). CONCLUSIONS: The use of metformin was not associated with higher cesarean section rates, compared to insulin. Instead, it was suggested a protective role of metformin on large gestational age rates. The concomitant use of dual therapy suggests more complex pregnancies, requiring closer surveillance that mitigate serious perinatal and obstetrical outcomes.

Making the most of cybercrime and fraud crime report data: a case study of UK Action Fraud.

Introduction: Researchers and public authorities are increasingly exploring the potential of administrative data to generate new insights. This includes recent work leveraging the opportunities of the crime report data collected by the UK's national reporting centre Action Fraud (AF). However, the quality of these data and its implications for data users have not been systematically analysed. Objectives: This paper outlines challenges and opportunities of using AF data in cybercrime and fraud victimisation research and practice and makes recommendations to improve the quality of this dataset. Methods: The author has undertaken two studies using samples of AF data pertaining to crime reports within the Welsh police forces, between 2014 and 2020. Quality diagnostic checks, reflections and methodological decisions were considered across each study. These were reviewed, key themes were identified and discussed with data users and a broader group of researchers to finalise the recommendations presented. Results: The strengths and limitations of AF data are discussed and grouped into themes, closely aligned with four quality dimensions widely used by statistical authorities. This includes an assessment of 1) the impact of under-reporting and 2) the purpose and rules of crime recording, on the relevance of the data to its users; 3) the accuracy and reliability of the data; 4) the consistency of recording and its impact on coherence and comparability; and 5) the accessibility and timeliness of the data. Conclusions: Recommendations are made to improve AF data to generate better quality insights across the dimensions of relevance, accuracy & reliability, coherence & comparability and the accessibility & timeliness of this dataset. Additionally, a data catalogue would enable frontline officers and researchers to make the most of this dataset, harnessing it to produce key insights for crime prevention, investigation, and victim support.

Psychological impact of COVID19 on community pharmacists and pharmacy technicians.

BACKGROUND: The unique situation related to the COVID-19 outbreak and the consequent worldwide lockdown can have a psychological impact on specific populations. Community pharmacists and pharmacy technicians, as essential healthcare workers on the front line who continue to do their jobs during this pandemic, can also experience psychological distress. Few data are available on the mental health impact of the COVID-19 pandemics on this population. OBJECTIVES: This study aimed to assess the psychological impact of COVID-19 on Spanish community pharmacists and pharmacy technicians during lockdown, and to identify factors contributing to psychological distress. METHODS: A cross-sectional, quantitative, correlational study was designed including 1162 pharmacy team members. The Impact of Event Scale revised was used to assess the psychological impact. Data collection was performed by emailing the instrument to individuals or by using social networks. RESULTS: Overall participants, almost 70% revealed severe levels of psychological impact. The outbreak of COVID-19 has significantly affected community pharmacy workers, the degree of which is related to gender, age, and feelings of fear/stress. CONCLUSIONS: In the initial phase of the lockdown associated with the COVID-19 outbreak, the majority of the respondents rated the psychological impact as severe. Our findings allow for the identification of factors associated with a greater psychological impact.

Glycaemic control during the COVID-19 pandemic: A catastrophe or a sign of hope for the person with type 1 Diabetes Mellitus?

Introduction: In a person with type 1 diabetes, any change concerning daily routine may lead to changes in glycaemic control. This study aimed to evaluate the impact of work and lockdown on glycaemic control in adults with type 1 diabetes. Material and methods: A retrospective cohort was stratified into three activity groups (g1-students/telework/laid-off; g2-unemployed/retired; g3-work without lockdown). Continuous and categorical variations (reductions ≥ 0.4%) in glycated haemoglobin were obtained in 2020 (t3:December/2019-March/2020; t4:April/2020-July/2020) and in homologous periods of 2019. Intragroup comparisons between years and intergroups in the same year were made. Regression models were developed to predict the variation of glycated haemoglobin in 2020. Results: 241 participants were included, with a significant reduction between t4 and t3 (vs. t2 and t1) in g1 (p < 0.001) and g2 (p = 0.025) and in 2020 in g1 (vs. g2, p < 0.001; vs. g3, p < 0.001). Only g1 presented superiority in the reduction ≥0.4% in glycated haemoglobin in 2020 (vs. 2019, p < 0.001; vs. g2, p < 0.001; vs. g3, p < 0.001). The insulin regimens were comparable and the development of hypoglycaemia was found to be superimposed between t3 and t4, except for g1, which was higher at t3 (p = 0.029). G1 correlated with continuous reductions (vs. g2, p = 0.001; vs. g3, p < 0.001) and ≥0.4% in glycated haemoglobin in 2020 (vs. g2, OR 3.6, p < 0.001; vs. g3, OR 12.7, p < 0.001), regardless of the age and duration of type 1 diabetes. Conclusions: A more stable and better glycaemic control was observed in participants who transitioned from face-to-face work to total lockdown.

Introducción: En una persona con diabetes tipo 1, cualquier cambio en la rutina diaria puede provocar cambios en el control glucémico. Este estudio tuvo como objetivo evaluar el impacto del trabajo y el confinamiento en el control glucémico en adultos con diabetes tipo 1. Material y métodos: Se estratificó una cohorte retrospectiva en tres grupos de actividad (g1-estudiantes/teletrabajo/despido; g2-desempleados/jubilados; g3-trabajo sin encierro). Se obtuvieron variaciones continuas y categóricas (reducciones ≥ 0,4%) en la hemoglobina glucosilada en 2020 (t3: diciembre/2019-marzo/2020; t4: abril/2020-julio/2020) y en períodos homólogos de 2019. Se desarrollaron modelos de regresión para predecir la variación de la hemoglobina glucosilada en 2020. Resultados: Se incluyeron 241 participantes, con una reducción significativa entre t4 y t3 (vs. t2 y t1) en g1 (p < 0,001) y g2 (p = 0,025) y en 2020 en g1 (vs. g2, p < 0,001; vs. g3, p < 0,001). Solo g1 demostró superioridad en la reducción ≥ 0,4% de la hemoglobina glucosilada en 2020 (vs. 2019, p < 0,001; vs. g2, p < 0,001; vs. g3, p < 0,001). Los regímenes de terapia con insulina fueron comparables y el desarrollo de hipoglucemia fue superponible entre t3 y t4, excepto para g1, que fue mayor en t3 (p = 0,029). G1 se correlacionó con reducciones continuas (vs. g2, p = 0,001; vs. g3, p < 0,001) y ≥ 0,4% en la hemoglobina glucosilada en 2020 (vs. g2, odds ratio [OR] 3,6, p < 0,001; vs. g3, OR 12,7, p < 0,001), independientemente de la edad y la duración de la diabetes tipo 1. Conclusiones: Se observó un control glucémico más optimizado a los participantes que pasaron del trabajo presencial al confinamiento total.

Ethical conflict among critical care nurses during the COVID-19 pandemic.

BACKGROUND: Ethical conflict is a problem with negative consequences, which can compromise the quality and ethical standards of the nursing profession and it is a source of stress for health care practitioners', especially for nurses. OBJECTIVES: The main aim of this study was to analyze Spanish critical care nurses' level of exposure to ethical conflict and its association with sociodemographic, occupational, and COVID-19-related variables. Research Design, Participants, and Research context: This was a quantitative cross-sectional descriptive study conducted among 117 nurses working in critical care units. Data collection tools were sociodemographic, occupational, and COVID-19-related questionnaires and previously validated Spanish version of Ethical Conflict in Nursing Questionnaire-Critical Care Version. ETHICAL CONSIDERATIONS: We obtained permission from the Ethics Committee and participants' informed consent. FINDINGS: Data indicates a moderate level of exposure to ethical conflicts. The most frequent ethical conflicts were related to situations about "treatment and clinical procedures." The most intensity of ethical conflicts was related to situations about "treatment and clinical procedures" and "dynamics of the service and working environment." No statistical significance was identified between the socio-demographic variables and level of exposure to ethical conflicts. However, for critical care nurses working in ICU, nurses with perceived worked stress had a higher level of exposure to ethical conflicts. Likewise, critical care nurses whose family/friends were infected with COVID-19 had a higher level of exposure. CONCLUSIONS: Critical care nurses experience a moderate level of exposure to ethical conflicts which is consistent with the results of previous studies. A deeper understanding of ethical conflicts in conflictive situations allows recognition of the situations that occur in everyday clinical practice, identification of the ethical conflicts, and facilitation of the nurses working in the challenging clinical situation.