Digital home care interventions and quality of primary care for older adults: a scoping review.

BACKGROUND: Population aging is forcing the transformation of health care. Long-term care in the home is complex and involves complex communication with primary care services. In this scenario, the expansion of digital health has the potential to improve access to home-based primary care; however, the use of technologies can increase inequalities in access to health for an important part of the population. The aim of this study was to identify and map the uses and types of digital health interventions and their impacts on the quality of home-based primary care for older adults. METHODS: This is a broad and systematized scoping review with rigorous synthesis of knowledge directed by the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The quantitative data were analyzed through descriptive statistics, and the qualitative data were analyzed through basic qualitative content analysis, considering the organizational, relational, interpersonal and technical dimensions of care. The preliminary results were subjected to consultation with stakeholders to identify strengths and limitations, as well as potential forms of socialization. RESULTS: The mapping showed the distribution of publications in 18 countries and in the Sub-Saharan Africa region. Older adults have benefited from the use of different digital health strategies; however, this review also addresses limitations and challenges, such as the need for digital literacy and technological infrastructure. In addition to the impacts of technologies on the quality of health care. CONCLUSIONS: The review gathered priority themes for the equitable implementation of digital health, such as access to home caregivers and digital tools, importance of digital literacy and involvement of patients and their caregivers in health decisions and design of technologies, which must be prioritized to overcome limitations and challenges, focusing on improving quality of life, shorter hospitalization time and autonomy of older adults.

Shelf-Life Management and Ripening Assessment of 'Hass' Avocado (Persea americana) Using Deep Learning Approaches.

Avocado production is mostly confined to tropical and subtropical regions, leading to lengthy distribution channels that, coupled with their unpredictable post-harvest behavior, render avocados susceptible to significant loss and waste. To enhance the monitoring of 'Hass' avocado ripening, a data-driven tool was developed using a deep learning approach. This study involved monitoring 478 avocados stored in three distinct storage environments, using a 5-stage Ripening Index to classify each fruit's ripening phase based on their shared characteristics. These categories were paired with daily photographic records of the avocados, resulting in a database of labeled images. Two convolutional neural network models, AlexNet and ResNet-18, were trained using transfer learning techniques to identify distinct ripening indicators, enabling the prediction of ripening stages and shelf-life estimations for new unseen data. The approach achieved a final prediction accuracy of 88.8% for the ripening assessment, with 96.7% of predictions deviating by no more than half a stage from their actual classifications when considering the best side of the samples. The average shelf-life estimates based on the attributed classifications were within 0.92 days of the actual shelf-life, whereas the predictions made by the models had an average deviation of 0.96 days from the actual shelf-life.

Machine learning determines stemness associated with simple and basal-like canine mammary carcinomas.

Simple and complex carcinomas are the most common type of malignant Canine Mammary Tumors (CMTs), with simple carcinomas exhibiting aggressive behavior and poorer prognostic. Stemness is an ability associated with cancer initiation, malignancy, and therapeutic resistance, but is still few elucidated in canine mammary tumor subtypes. Here, we first validated, using CMT samples, a previously published canine one-class logistic regression machine learning algorithm (OCLR) to predict stemness (mRNAsi) in canine cancer cells. Then, using the canine mRNAsi, we observed that simple carcinomas exhibit higher stemness than complex carcinomas and other histological subtypes. Also, we confirmed that stemness is higher and associated with basal-like CMTs and with NMF2 metagene signature, a tumor-specific DNA-repair metagene signature. Using correlation analysis, we selected the top 50 genes correlated with higher stemness, and the top 50 genes correlated with lower stemness and further performed a gene set enrichment analysis to observe the biological processes enriched for these genes. Finally, we suggested two promise stemness-associated targets in CMTs, POLA2 and APEX1, especially in simple carcinomas. Thus, our work elucidates stemness as a potential mechanism behind the aggressiveness and development of canine mammary tumors, especially in simple carcinomas, describing evidence of a promising strategy to target this disease.

Patient satisfaction and digital health in primary health care: a scoping review protocol.

Introduction: Using digital health in primary health care (PHC) contributes to reducing costs and travel time, achieving global development goals, improving access, quality and longitudinality of care, and managing health crises. Its evaluation must go beyond the technical-operational aspects to include patient satisfaction, a key element in assessing the quality of care. Objective: To identify and map patient satisfaction (expectations, desires, cultural values) about the adoption of digital health strategies and assess their impact on the quality of care in PHC. Methods: The review will follow the recommendations proposed by the Joanna's Briggs Institute (JBI) manual, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and the methodology proposed by Arksey and O'Malley and Levac et al. and will be conducted in nine stages. The search will be conducted in health studies databases (MEDLINE via PubMed, EMBASE, CINAHL, Web of Science, and BVS), gray literature, and preprint repositories (Google Scholar and MedRxiv). Two reviewers will select the studies, and the third will analyze possible conflicts. The inclusion criteria comprise studies that have been made available in their entirety, whether they are primary studies or short communications, as well as the following materials extracted from the gray literature: preprints, manuals, government documents, books, guidelines, theses and dissertations. Exclusion criteria include literature reviews, abstracts, books, conference archives, letters to the editor, duplicates and opinion articles. Data will be analyzed by content analysis and inferential statistics. This protocol is registered on the Open Science Framework (OSF) under DOI 10.17605/OSF.IO/PUJDB. Results: The study aims to understand aspects related to the expectations, desires, and cultural values of patients from different countries, as well as the strengths and critical nodes of the use of digital health on the quality of care in PHC.

Preparation and validation of the instrument "QualiAPS digital-Brazil" for assessing digital health care in primary health care: a required tool.

Introduction: The use of Information and Communication Technologies in the field of health is increasing across the world, demarcating the field of digital health. The goal of this study is to formulate and validate a matrix of indicators, design assessment scripts and indicate data collection techniques for assessing the quality of digital health care in Brazilian Primary Health Care (PHC). Methodology: This is a validation study divided into three phases: preparation of the instrument, analysis of validity and pilot study. The instrument was prepared based on the PHC assessment model from a literature review; the analysis of validity used the Delphi technique associated with the nominal group and the evidence from the literature reference. In the pilot study, audio-recorded interviews were conducted with strategic primary care actors. Results: The matrix of indicators "QualiAPS Digital-Brazil" introduces a set of 37 indicators, distributed into three distinct components and their respective dimensions. The component "Structure" includes the dimension "Resources"; the component "Processes" includes the dimensions "Technical," "Organizational" and "Relational"; and the component "Results" includes the dimensions "Short-Term Results" and "Medium-Term Results." The general values obtained for CVI and IRR were 0.89 and 1.00; respectively. Therefore, it was possible to design assessment scripts and indicate qualitative data collection techniques for assessing digital health in Brazilian PHC. Conclusion: The instrument presented was validated regarding its relevance, content and theoretical support to evaluate the quality of digital health care, supporting decision-making by managers and health professionals in the search for improving remote primary care provided to the population.

Ainda a esperançar: escola pública como dispositivo da rede de apoio aos casos de violência contra crianças e adolescentes

O presente artigo apresenta uma proposta de pesquisa ainda em fase de implementação. O objetivo desse estudo é compreender a função da escola pública como um dispositivo essencial de apoio à rede de atenção à criança e adolescente vítima de violência. Em uma abordagem qualitativa de análise, esta pesquisa se baseia na pedagogia de Paulo Freire, entrelaçada à saúde coletiva na perspectiva da territorialidade. Para isso, recorremos à investigação exploratória aplicada de forma dedutiva, como coleta dedados e contextualização da temática, por meio da literatura disponível em plataformas online. A discussão e os resultados são frutos de uma análise crítica, baseada no conceito Freiriano de ação-reflexão-ação. Acreditamos que a educação em saúde, junto às instituições de ensino público, proporcionará, às crianças e adolescentes, um ambiente de troca de afetos e saberes, bem como proteção e prevenção delas próprias em suas comunidades.

Acompanhamento dermatológico de enfermagem na estratégia saúde da família: um relato de experiência / Dermatological nursing care in the family health strategy: an experience report / Cuidados de enfermería dermatológica en la estrategia de salud familiar: informe de una experiencia

O desenvolvimento de lesões por pressão vem sendo um tema bastante discutido dentro e fora do âmbito hospitalar, sendo considerado um indicador de qualidade da assistência hospitalar, quando o aparecimento ocorre mediante uma internação. Cabe ao enfermeiro o acompanhamento dermatológico, avaliação e prescrição de coberturas e correlatos, consoante o estágio da lesão por pressão. Por esta razão, este estudo teve como objetivo descrever a experiência de graduandos de enfermagem durante acompanhamento dermatológico de uma pessoa idosa. Trata-se de um estudo descritivo do tipo relato de experiência realizado entre os meses de fevereiro e maio de 2021. Através da experiência relatada neste estudo, foi possível compreender a complexidade e relevância do cuidado humanizado, e os desafios enfrentados pelo enfermeiro da Estratégia Saúde da Família nos cuidados à pessoa idosa com lesão por pressão. Do ponto de vista acadêmico, essa experiência proporcionou aos alunos confrontar os conhecimentos teóricos acerca do assunto, além de incorporar a importância do olhar holístico para o usuário.

The development of pressure injuries has been a much discussed topic inside and outside the hospital environment, being considered an indicator of the quality of hospital care when the appearance occurs during hospitalization. The trained nurse is responsible for dermatological follow-up, evaluation and prescription of dressings and related items, depending on the stage of the pressure injury. For this reason, this study aimed to describe the experience of nursing students during the dermatological follow-up of an elderly person. This is a descriptive study of the experience report type carried out between the months of February and May 2021. Through the experience reported in this study, it was possible to understand the complexity and relevance of humanized care, and the challenges faced by nurses in the Health Strategy of the Family in the care of the elderly with pressure injuries. From an academic point of view, this experience allowed students to confront theoretical knowledge about the subject, in addition to incorporating the importance of a holistic view for the user.

El desarrollo de las lesiones por presión ha sido un tema muy discutido dentro y fuera del ámbito hospitalario, siendo considerado un indicador de la calidad de la atención hospitalaria cuando su aparición ocurre durante la hospitalización. La enfermera capacitada es responsable del seguimiento dermatológico, evaluación y prescripción de apósitos y artículos relacionados, según la etapa de la lesión por presión. Por eso, este estudio tuvo como objetivo describir la experiencia de estudiantes de enfermería durante el seguimiento dermatológico de una persona mayor. Se trata de un estudio descriptivo del tipo relato de experiencia realizado entre los meses de febrero y mayo de 2021. A través de la experiencia relatada en este estudio fue posible comprender la complejidad y relevancia del cuidado humanizado, y los desafíos enfrentados por los enfermeros en el Estrategia Salud de la Familia en el cuidado del anciano con lesiones por presión. Desde el punto de vista académico, esta experiencia permitió a los estudiantes confrontar conocimientos teóricos sobre el tema, además de incorporar la importancia de una mirada holística para el usuario.

Expression of LIN28A/B and Let-7 miRNAs in canine mammary carcinomas / Expressão de LIN28A/B e Let-7 miRNAs em carcinomas mamários caninos

LIN28 is a RNA-binding protein including two highly conserved homologous, LIN28A and LIN28B. Proto-oncogenes such as LIN28A and LIN28B are generally targeted by the let-7 miRNAs in different types of human cancers. Here, we determined the expression of LIN28A in canine mammary tumor samples and the LIN28/let-7 pathway in canine mammary cell lines. In those cell lines, we identified a functional LIN28/let-7 pathway which exhibited high expression of let-7 members and low expression of its targets, including LIN28A and LIN28B. However, the mammary carcinoma tissue samples showed a frequent expression of LIN28A being expressed mainly in the epithelial cells. No association was observed between LIN28A expression and histopathological classification and grade, TNM and survival time. Our results suggested a possible role of the LIN28A protein in the development of canine mammary carcinomas due to the high frequency observed in the tumor samples (28 of 32). The in vitro experiments suggested that the LIN28/let-7 pathway is active in the tumor cells evaluated. However, more studies are necessary to elucidate the exact role of LIN28/let-7 pathway in canine mammary carcinomas.

LIN28 é uma proteína de ligação ao RNA, com duas formas homólogas altamente conservadas, LIN28A e LIN28B. Os proto-oncogenes LIN28A e LIN28B são regulados pela família de miRNAs let-7 em diferentes tipos de cânceres em humanos. No presente trabalho, o objetivo foi determinar a expressão de LIN28A em amostras de tumor mamário de cadelas e a via LIN28/let-7 em linhagens celulares mamárias caninas. Nestas linhagens, através das técnicas de qPCR e RNAseq, foi identificado que a via LIN28/let-7 apresenta-se funcional, com alta expressão dos membros da família let-7 e baixa expressão de seus alvos, entre eles LIN28A e LIN28B. No entanto, as amostras de tecidos de carcinomas mamários caninos demonstraram expressão frequente de LIN28A, sendo observada principalmente em células epiteliais. Não foram observadas associações entre expressão de LIN28A com classificação e gradação histopatológicas, TNM e tempo de sobrevida. Nossos resultados sugerem uma possível relação da proteína LIN28A no desenvolvimento de carcinomas mamários caninos devido à alta frequência observada nas amostras tumorais (28 de 32). Os experimentos in vitro sugerem que a via LIN28/let-7 é ativa nas linhagens celulares caninas avaliadas. Entretanto, estudos funcionais ainda são necessários para elucidar a função exata da via LIN28/let-7 nos carcinomas mamários caninos.

Ventilação mecânica em pediatria: conceitos básicos / Mechanical ventilation in pediatrics: basic concepts

O emprego da ventilação mecânica em Pediatria implica riscos próprios e sua aplicação deve ser cercada de cuidados específicos. Dentro da sala cirúrgica, a anestesia pode produzir diferentes graus de depressão respiratória, sendo necessário o uso de vários modos ventilatórios. A partir do melhor entendimento da fisiologia respiratória e da ampliação do conhecimento acerca do tema, inovações tecnológicas permitiram sensível melhoria na assistência ventilatória prestada aos pacientes pediátricos. O objetivo do presente artigo é revisar conceitos a respeito da fisiologia respiratória da criança, dos sistemas de ventilação em anestesia pediá- trica e dos modos ventilatórios mais utilizados nesse grupo de pacientes - os quais possibilitam reduzir os índices de complicações relacionadas à ventilação mecânica.

The use of pediatric mechanical ventilation involves inherent risks, and its application should be surrounded by specific care. In the operating room, anesthesia can produce different degrees of respiratory depression and the use of various ventilation modes is required. From a better understanding of respiratory physiology and the expansion of the knowledge about this subject, technological innovations have enabled a significant improvement in ventilatory assistance to pediatric patients. The purpose of this article is to review concepts on respiratory physiology of the child, the ventilation systems in pediatric anesthesia and ventilation modes often used in this group of patients - all these enable us to reduce the rate of complications related to mechanical ventilation.