Environmental determinants of population health in urban settings. A systematic review.

BACKGROUND: Population health is influenced by interactions between environmental determinants, which are captured by dimensions and indicators. This study aims to systematically review key environmental determinants and respective dimensions and indicators, relevant to evaluate population health in urban settings, and to understand their potential implications into policies. METHODS: A search of literature published between 2008 and 2018 was conducted in PubMed, Web of Science, Scopus and SciELO Portugal databases, on studies with evidence on association between an environmental determinant and a health outcome in urban contexts. Health determinants, dimensions and indicators researched in the selected studies were synthetized, and associations analyzed. An independent assessment of quality of the studies was performed. Key conclusions and policy recommendations were extracted to build a framework to analyze environment related population health and policies in urban settings. RESULTS: Ninety four studies of varied methodological approaches and quality met the inclusion criteria. The review identified positive associations between all environmental determinants -socioeconomic, built environment, natural environment, healthcare, behaviors, and health outcomes - overall mortality and morbidity, in urban settings. Improvements in income, education, air quality, occupation status, mobility and smoking habits indicators have positive impact in overall mortality and chronic diseases morbidity indicators. Initiatives to improve population health in which policymakers can be more evidence-informed include socioeconomic, natural environment and built environment determinants. CONCLUSIONS: There is scope and need to further explore which environmental determinants and dimensions most contribute to population health to create a series of robust evidence-based measures to better inform urban planning policies.

Chronic respiratory diseases and quality of life in elderly nursing home residents.

Few studies have assessed the quality of life (QOL) related to chronic respiratory diseases in the elderly. In the framework of the geriatric study on the health effects of air quality in elderly care centers (GERIA) study, a questionnaire was completed by elderly subjects from 53 selected nursing homes. It included various sections in order to assess respiratory complaints, QOL (World Health Organization QOL (WHOQOL)-BREF), and the cognitive and depression status. The outcome variables were the presence of a score lower than 50 (<50) in each of the WHOQOL-BREF domains (physical health, psychological health, social relationships, and environmental health). Chronic bronchitis, frequent cough, current wheezing, asthma, and allergic rhinitis were considered as potential risk factors. The surveyed sample was (n = 887) 79% female, with a mean age of 84 years (SD: 7 years). In the multivariable analysis, a score of <50 in the physical domain was associated with wheezing in the previous 12 months (odds ratio (OR): 2.03, confidence interval (CI): 1.25-3.31) and asthma (OR: 1.95, CI: 1.12-3.38). The psychological domain was related with a frequent cough (OR: 1.43, CI: 0.95-2.91). A score of <50 in the environmental domain was associated with chronic bronchitis (OR: 2.89, CI: 1.34-6.23) and emphysema (OR: 3.89, CI: 1.27-11.88). In view of these findings, the presence of respiratory diseases seems to be an important risk factor for a low QOL among elderly nursing home residents.

CO(2) concentration in day care centres is related to wheezing in attending children.

UNLABELLED: Poor ventilation at day care centres (DCCs) was already reported, although its effects on attending children are not clear. This study aimed to evaluate the association between wheezing in children and indoor CO2 (a ventilation surrogate marker) in DCC and to identify behaviours and building characteristics potentially related to CO2. In phase I, 45 DCCs from Lisbon and Oporto (Portugal) were selected through a proportional stratified random sampling. In phase II, 3 months later, 19 DCCs were further reassessed after cluster analysis for the greatest difference comparison. In both phases, children's respiratory health was assessed by ISAAC-derived questionnaires. Indoor CO2 concentrations and building characteristics of the DCC were evaluated in both phases, using complementary methods. Mixed effect models were used to analyze the data. In phase I, which included 3,186 children (mean age 3.1 ± 1.5 years), indoor CO2 concentration in the DCC rooms was associated with reported wheezing in the past 12 months (27.5 %) (adjusted odds ratio (OR) for each increase of 200 ppm 1.04, 95 % CI 1:01 to 1:07). In phase II, the association in the subsample of 1,196 children seen in 19 out of the initial 45 DCCs was not significant (adjusted OR 1.02, 95 % CI 0.96 to 1.08). Indoor CO2 concentration was inversely associated with the practices of opening windows and internal doors and with higher wind velocity. A positive trend was observed between CO2 and prevalence of reported asthma (4.7 %). CONCLUSION: Improved ventilation is needed to achieve a healthier indoor environment in DCC.

Immunotherapy in Elderly Patients-Single-Center Experience.

Cancer management faces a substantial challenge posed by the aging demographic. Aging is marked by accumulated DNA damage, and this phenomenon is implicated in the process of tumorigenesis. The concept of immunosenescence, postulated to manifest in elderly individuals, is defined by an age-related decline in T cells and a simultaneous elevation in proinflammatory status, leading to a diminished efficacy in response to immunotherapy. Notably, despite the rising prevalence of cancer in the elderly population, their underrepresentation in clinical trials persists. This underscores the unmet need to evaluate the safety and efficacy of cancer treatment in the elderly. This retrospective, single-center cohort study aimed to assess and evaluate the effectiveness and safety of immunotherapy in patients compared to younger individuals with metastatic solid tumors receiving ICI. A total of 220 patients were included, mostly males, with a median age of 64. The proportion of patients ≥ 65 years old was 56.5%. The use of ICI showed no significant differences concerning overall survival (OS) and progression-free survival (PFS) among age groups across different cancer types (melanoma, non-small-cell lung cancer (NSCLC), renal, and bladder cancer; p = 0.388). Concerning the response to treatment in renal cancer patients, a significant difference was observed (p = 0.041), suggesting a potential negative impact of age on the treatment response. In patients that presented immune-related adverse events (irAEs), oral corticosteroid therapy was marginally associated (p = 0.059) with the elderly population. When evaluating the NSCLC population alone (n = 131, 59.5%), our study revealed a strong association between the development of irAEs, patients' PFS and OS, and the duration of ICI treatment, but not directly correlated with age. The NSCLC elderly population presented a marginally greater number of irAEs, although without statistical significance (p = 0.86). ICI maintained efficacy and safety in elderly patients, challenging the notion that age alone should determine treatment decisions. The findings emphasize the necessity of a comprehensive geriatric assessment rather than relying solely on chronological age for personalized cancer treatment in the elderly population. Further prospective studies are needed to better understand immune responses in older adults and derive predictive biomarkers for cancer treatment.

Chemotherapy: A partnership with immunotherapy in non-small cell lung cancer.

Chemotherapy (CT) and immunotherapy (IO) act synergically in the treatment of non-small cell lung cancer (NSCLC). However, the molecular basis of such interaction is poorly understood. The aim of this review was to explore the mechanisms of CT to potentiate the immune system and, consequently, the action of IO. The most up-to-date knowledge concerning the interaction of CT and IO in NSCLC was reviewed and a bibliographic search was made in PubMed/Medline database, using the mentioned keywords, with preference given to recently published articles in English. In addition to the direct cytotoxic effect, CT affects the immune system leading indirectly to cell death. The immune response triggered by PD-1 inhibition is enhanced by the cytotoxic immunogenic effects of CT. This potentiation phenomenon occurs due to an increase in effector cells relatively to regulatory cells, inhibition of myeloid derived suppressor cells, increased potential for cross-presentation by dendritic cells after the death of tumor cells or blocking the STAT6 pathway to increase dendritic cell activity. In conclusion, the effects of CT on the immune system work in synergy with the actions of IO, transforming "cold" tumors into "hot" tumors, which are more visible to the immune system.

Best Supportive Care of the Patient with Oesophageal Cancer.

BACKGROUND: Oesophageal cancer patients have poor survival, and most are unfit for curative or systemic palliative treatment. This article aims to review the best supportive care for oesophageal cancer, focusing on the management of its most frequent or distinctive symptoms and complications. METHODS: Evidence-based review on palliative supportive care of oesophageal cancer, based on Pubmed search for relevant clinical practice guidelines, reviews and original articles, with additional records collected from related articles suggestions, references and societies recommendations. RESULTS: We identified 1075 records, from which we screened 138 records that were related to oesophageal cancer supportive care, complemented with 48 additional records, finally including 60 records. This review summarizes the management of oesophageal cancer-related main problems, including dysphagia, malnutrition, pain, nausea and vomiting, fistula and bleeding. In recent years, several treatments have been developed, while optimal management is not yet standardized. CONCLUSION: This review contributes toward improving supportive care and decision making for oesophageal cancer patients, presenting updated summary recommendations for each of their main symptoms. A robust body of evidence is still lacking, and the best supportive care decisions should be individualized and shared.

Estágio III - Enfermagem de cuidados de saúde à família em contexto de Unidade de Saúde Familiar / Stage III - Family health care nursing in the context of a Family Health Unit

Enquadramento: O Nascimento de um novo ser é considerado um acontecimento marcante que ocorre no seio de uma família. Esta é uma etapa importante do ciclo vital, caracterizado por sucessivas transformações psicossociais, desequilíbrios biofísicos, consolidação da relação entre membros da família e uma reorganização do relacionamento conjugal e familiar. As orientações emanadas pela Organização Mundial de Saúde (OMS) e pelo Ministério da Saúde (MS), reforçam a necessidade de fortalecer o cuidado pós-natal através da visita domiciliária. Esta após o nascimento é reconhecida como uma estratégia fundamental uma vez que fornece elementos efetivos dos cuidados ao Recém-Nascido (RN). Na visita domiciliária, promove-se a relação de proximidade entre equipa de saúde e família, contribuindo para a vigilância e promoção da saúde. Objetivo: analisar as competências comuns e especificas da enfermagem especializada na área da saúde familiar, adquiridas no âmbito do ensino clínico e mapear o conhecimento sobre intervenções protocoladas do enfermeiro de família para a visita domiciliária (VD) ao RN e Família. Metodologia: realizou uma análise critica-reflexiva sobre as competências adquiridas e desenvolvidas no ensino clínico e desenvolveu uma revisão sistemática de literatura. A pesquisa foi realizada em janeiro e fevereiro de 2022. Através da base de dados eletrónica do site da Ordem dos Enfermeiros, acesso reservado, EBSCOhot, selecionando a base de dados CINAHL e MEDLINE complete e através da base de dados da OE de acesso livre RCAP e Biblioteca Virtual em saúde, foram encontrados 32 resultados. Destes, 27 foram eliminados e 5 foram selecionados. O friso temporal em que incidiu o estudo decorreu de 2011 a 2021. Os resultados foram extraídos e sintetizados na forma de tabela e resumo narrativo. Resultados: O ensino clínico consolidou os conhecimentos científicos adquiridos ao longo da sua formação. Desenvolveu competências do enfermeiro especialista em enfermagem comunitária, na área da saúde familiar. Foram incluídos cinco estudos na RSL. No seguimento da RSL e de forma a recolher contributos para a construção de uma proposta de protocolo realizou um estudo descritivo, exploratório, recorrendo à metodologia descritiva. Neste estudo a amostra foi constituída por 13 enfermeiros de três unidades de saúde. Todos eles contribuíram com sugestões para a construção da proposta de protocolo e evidenciaram a sua importância. Conclusão: com base nos achados da RSL e no estudo realizado é apresentada uma proposta de protocolo para a visita domiciliária ao RN e família.

Background: The birth of a new being is considered a landmark event that occurs within a family. This is an important stage in the life cycle, characterized by successive psychosocial transformations, biophysical imbalances, consolidation of the relationship between family members and a reorganization of marital and family relationships. The guidelines issued by the World Health Organization (WHO) and the Ministry of Health (MS) reinforce the need to strengthen postnatal care through home visits. This after birth is recognized as a fundamental strategy as it provides effective elements of care for the Newborn (NB). During home visits, a close relationship is promoted between the healthcare team and the family, contributing to health surveillance and promotion. Objective: to analyze the common and specific skills of specialized nursing in the area of family health, acquired within the scope of clinical teaching and to map the knowledge about protocolized interventions of the family nurse for the home visit (HV) to the NB and Family. Methodology: carried out a critical-reflexive analysis of the skills acquired and developed in clinical teaching and developed a systematic literature review. The research was carried out in January and February 2022. Through the electronic database of the Order of Nurses website, access reserved, EBSCOhot, selecting the CINAHL and MEDLINE complete database and through the free access OE database RCAP and Virtual Health Library, 32 results were found. Of these, 27 were eliminated and 5 were selected. The period in which the study focused ran from 2011 to 2021. The results were extracted and synthesized in the form of a table and narrative summary. Results: Clinical teaching consolidated the scientific knowledge acquired throughout their training. Developed nursing specialist nurse skills community, in the area of family health. Five studies were included in the RSL. Following the RSL and in order to collect contributions for the construction of a protocol proposal, a descriptive, exploratory study was carried out, using descriptive methodology. In this study, the sample consisted of 13 nurses from three health units. They all contributed with suggestions for the construction of the protocol proposal and highlighted its importance. Conclusion: based on the RSL findings and the study carried out, a proposed protocol for home visits to the newborn and family.

[Breast cancer at Pico Island (1998-2008): an epidemiological perspective]. / Cancro da mama na ilha do pico (1998-2008): uma perspectiva epidemiológica.

INTRODUCTION: Neoplasic disease has been assuming an increasingly relevant role in the world's public health. Breast cancer is the most common cancer and the second cause of death by neoplasia in women. In the Portuguese population, breast cancer is the main cause of death by neoplasia in females. Among the Azorean women, the most frequently diagnosed malignant tumor is breast cancer, Pico Island being the third in terms of cancer incidence in the region. The risk factors are well known, well established and some of them can be prevented. Despite the great incidence of breast cancer, in the general population, particularly among the youngest, the knowledge about the disease is quite limited. The aims of this study are to characterize and identify the risk factors of women with breast cancer diagnose between 1998 and 2008 residing in Pico's island and, simultaneously to evaluate the knowledge of the students in Pico island about this disease. METHODS AND POPULATION: The method used for the gathering of the data in both cases was an anonymous and confidential questionnaire. In study 1 the questionnaire was conducted by an interviewer after the women's consent. Study 2 was performed in the three secondary schools of Pico island. RESULTS: The incidence rate of breast cancer in Pico island women is higher than the national incidence rate. There was an enormous variability in the incidence rates calculated for each year, with no clear tendency. The main responsible for the appearance of breast cancer in this population could be a conjugation of factors and not only a single isolated factor. The risk factors that stand out are: sedentariness (71.4%), family history (47.6%) and obesity (44.4%). The 295 students interviewed aged between 15 and 21 years. Of the total, 43 had relatives with breast cancer, however the majority (56.3%) assumes to be little informed about this disease. CONCLUSIONS: Through study 1 we conclude that there is a combination of hereditary and environmental risk factors, modifiable and non modifiable risk factors that may contribute to the onset of breast cancer. It is important to encourage changes in the life style of the women and rising of awareness towards risk factors. For the study of the student population, we conclude that the students have a very limited degree of knowledge of the disease; however, they assumed the will to more information, which leaves an open door for future formation and awareness actions.