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Two approximations of the integral of a class of sinusoidal composite functions, for which an explicit form does not exist, are derived. Numerical experiments show that the proposed approximations yield an error that does not depend on the width of the integration interval. Using such approximations, definite integrals can be computed in almost real-time.

Mouse has been extensively used as a model organism in many studies to characterize biological pathways and drug effects and to mimic human diseases. Similar DNA sequences between both species facilitate these types of experiments. However, much less is known about the mouse epigenome, particularly for DNA methylation. Progress in delivering mouse DNA methylomes has been slow due to the currently available time-consuming and expensive methodologies. Following the great acceptance of the human DNA methylation microarrays, we have herein validated a newly developed DNA methylation microarray (Infinium Mouse Methylation BeadChip) that interrogates 280,754 unique CpG sites within the mouse genome. The CpGs included in the platform cover CpG Islands, shores, shelves and open sea sequences, and loci surrounding transcription start sites and gene bodies. From a functional standpoint, mouse ENCODE representative DNase hypersensitivity sites (rDHSs) and candidate cis-Regulatory Elements (cCREs) are also included. Herein, we show that the profiled mouse DNA methylation microarray provides reliable values among technical replicates; matched results from fresh frozen versus formalin-fixed samples; detects hemimethylated X-chromosome and imprinted CpG sites; and is able to determine CpG methylation changes in mouse cell lines treated with a DNA demethylating agent or upon genetic disruption of a DNA methyltransferase. Most important, using unsupervised hierarchical clustering and t-SNE approaches, the platform is able to classify all types of normal mouse tissues and organs. These data underscore the great features of the assessed microarray to obtain comprehensive DNA methylation profiles of the mouse genome., We thank the CERCA Programme/Generalitat de Catalunya for institutional support. This work was supported by the Health Department PERIS-project no. SLT/002/16/00374 and AGAUR-project no. 2017SGR1080 of the Catalan Government (Generalitat de Catalunya); Ministerio de Ciencia e Innovación (MCI), Agencia Estatal de Investigación (AEI), and European Regional Development Fund (ERDF) project no. RTI2018-094049-B-I00 and PID2020-117284RB-I00; the Cellex Foundation; Marie Sklodowska-Curie Fellowship no. 895979 from the European Commission (BNV); and ‘la Caixa’ Banking Foundation (LCF/PR/GN18/51140001)., Peer Reviewed, Postprint (published version)

Background: Chimeric antigen receptor (CAR) T cells directed against CD19 (CART19) are effective in B-cell malignancies, but little is known about the molecular factors predicting clinical outcome of CART19 therapy. The increasingly recognized relevance of epigenetic changes in cancer immunology prompted us to determine the impact of the DNA methylation profiles of CART19 cells on the clinical course. Methods: We recruited 114 patients with B-cell malignancies, comprising 77 patients with acute lymphoblastic leukemia and 37 patients with non-Hodgkin lymphoma who were treated with CART19 cells. Using a comprehensive DNA methylation microarray, we determined the epigenomic changes that occur in the patient T cells upon transduction of the CAR vector. The effects of the identified DNA methylation sites on clinical response, cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, event-free survival, and overall survival were assessed. All statistical tests were 2-sided. Results: We identified 984 genomic sites with differential DNA methylation between CAR-untransduced and CAR-transduced T cells before infusion into the patient. Eighteen of these distinct epigenetic loci were associated with complete response (CR), adjusting by multiple testing. Using the sites linked to CR, an epigenetic signature, referred to hereafter as the EPICART signature, was established in the initial discovery cohort (n = 79), which was associated with CR (Fisher exact test, P < .001) and enhanced event-free survival (hazard ratio [HR] = 0.36; 95% confidence interval [CI] = 0.19 to 0.70; P = .002; log-rank P = .003) and overall survival (HR = 0.45; 95% CI = 0.20 to 0.99; P = .047; log-rank P = .04;). Most important, the EPICART profile maintained its clinical course predictive value in the validation cohort (n = 35), where it was associated with CR (Fisher exact test, P < .001) and enhanced overall survival (HR = 0.31; 95% CI = 0.11 to 0.84; P = .02; log-rank P = .02

We thank CERCA Programme/Generalitat de Catalunya for institutional support. This work was supported by the Health Department PERIS-project no. SLT/002/16/00374 and AGAUR-projects no. 2017SGR1080 of the Catalan Government (Generalitat de Catalunya); Ministerio de Ciencia e Innovación (MCI), Agencia Estatal de Investigación (AEI) and European Regional Development Fund (ERDF) project no. RTI2018-094049-B-I00; the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (Grant agreement No. 743168); the Varda and Boaz Dotan Research Center in Hemato-oncology affiliated to the Tel Aviv University; the Cellex Foundation; and “la Caixa” Banking Foundation (LCF/PR/GN18/51140001). ME is an ICREA Research Professor., Peer Reviewed, "Article signat per 12 autors/es: Alberto Bueno-Costa, David Piñeyro, Carlos A. García-Prieto, Vanessa Ortiz-Barahona, Laura Martinez-Verbo, Natalie A. Webster, Byron Andrews, Nitzan Kol, Chen Avrahami, Sharon Moshitch-Moshkovitz, Gideon Rechavi & Manel Esteller", Postprint (published version)

The leukocyte specific β2-integrin LFA-1, and its ligand ICAM-1 expressed on endothelial cells (ECs), are involved in the arrest, adhesion and transendothelial migration of leukocytes. Although the role of mechanical forces on LFA-1 activation is wellestablished, the impact of forces on its major ligand ICAM-1, has received less attention. Using a parallel-plate flow-chamber combined with confocal and super-resolution microscopy, we show that prolonged shear-flow induces global translocation of ICAM-1 on ECs upstream of flow direction. Interestingly, shear-forces caused actin rearrangements and promoted actin-dependent ICAM-1 nanoclustering prior to LFA-1 engagement. T-cells adhered to mechanically pre-stimulated ECs or nanoclustered ICAM-1 substrates, developed a pro-migratory phenotype, migrated faster and exhibited shorter-lived interactions with ECs than when adhered to non-mechanically stimulated ECs, or to monomeric ICAM-1 substrates. Together, our results indicate that shearforces increase ICAM-1/LFA-1 bonds due to ICAM-1 nanoclustering, strengthening adhesion and allowing cells to exert higher traction forces required for faster migration. Our data also underscores the importance of mechanical forces regulating the nanoscale organization of membrane receptors and their contribution to cell adhesion regulation., Peer Reviewed, Postprint (author's final draft)

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

With improved healthcare, the Down syndrome (DS) population is both growing and aging rapidly. However, with longevity comes a very high risk of Alzheimer's disease (AD). The LIFE-DSR study (NCT04149197) is a longitudinal natural history study recruiting 270 adults with DS over the age of 25. The study is designed to characterize trajectories of change in DS-associated AD (DS-AD). The current study reports its cross-sectional analysis of the first 90 subjects enrolled. Plasma biomarkers phosphorylated tau protein (p-tau), neurofilament light chain (NfL), amyloid β peptides (Aβ1-40, Aβ1-42), and glial fibrillary acidic protein (GFAP) were undertaken with previously published methods. The clinical data from the baseline visit include demographics as well as the cognitive measures under the Severe Impairment Battery (SIB) and Down Syndrome Mental Status Examination (DS-MSE). Biomarker distributions are described with strong statistical associations observed with participant age. The biomarker data contributes to understanding DS-AD across the spectrum of disease. Collectively, the biomarker data show evidence of DS-AD progression beginning at approximately 40 years of age. Exploring these data across the full LIFE-DSR longitudinal study population will be an important resource in understanding the onset, progression, and clinical profiles of DS-AD pathophysiology.

Aims: To conduct an integrative review of published studies on the nutritional status of adults and the elderly and the factors related to it. Method: This is an integrative review carried out in the databases: LILACS and SCIELO, in Portuguese, using the indexers: nutritional status, nutritional surveys, nutritional assessment, adults and the elderly. Results: There was a high prevalence of individuals with overweight and the factors positively associated, in most studies, were sociodemographic. Overweight, in adults, was found in all income groups, marital status as an indicator for women and the upper economic class for men. In the elderly, the factors associated with an inactive occupational situation and residents of the urban area were observed. Conclusion: we identified an increasing prevalence of disorders in nutritional status among adults and the elderly, with excess weight showing a more significant growth than obesity., Objetivo: Realizar uma revisão integrativa de estudos publicados acerca do estado nutricional de adultos e idosos e os fatores a ele relacionados. Método: Trata-se de uma revisão integrativa realizada nas bases de dados: LILACS e SCIELO, em língua portuguesa, usando os indexadores: estado nutricional, inquéritos nutricionais, avaliação nutricional, adultos e idosos. Resultados: Constatou-se elevada prevalência de indivíduos com excesso de peso e os fatores positivamente associados, na maioria dos estudos, foram os sociodemográficos. O excesso de peso, em adultos, foi encontrado em todos os grupos de renda, o estado civil como indicador para as mulheres e a classe econômica alta para os homens. Já nos idosos os fatores associados a situação ocupacional inativa e residentes da zona urbana. Conclusão: identificamos prevalência crescente dos distúrbios no estado nutricional entre os adultos e idosos, com o excesso de peso apresentando um crescimento mais significativo do que a obesidade., Objetivo: Realizar una revisión integradora de los estudios publicados sobre el estado nutricional de adultos y ancianos y los factores relacionados con él. Método: Se trata de una revisión integradora realizada en las bases de datos: LILACS y SCIELO, en portugués, utilizando los indexadores: estado nutricional, encuestas nutricionales, valoración nutricional, adultos y ancianos. Resultados: Hubo una alta prevalencia de individuos con sobrepeso y los factores asociados positivamente, en la mayoría de los estudios, fueron sociodemográficos. El sobrepeso, en adultos, se encontró en todos los grupos de ingresos, el estado civil como indicador para las mujeres y la clase económica alta para los hombres. En los ancianos, los factores asociados a una situación ocupacional inactiva y residentes del área urbana, por otro lado. Conclusión: identificamos una prevalencia creciente de trastornos en el estado nutricional entre adultos y ancianos, mostrando el exceso de peso un crecimiento más significativo que la obesidad.

Objective: To evaluate factors associated with low birth weight in a reference maternity in Piauí. Method: Descriptive cross-sectional study, carried out in Teresina between November 2018 and April 2019. The sample consisted of 385 postpartum women. Primary data were used, through interviews, and secondary data. The chisquare test and Fisher's Exact test wer used to assess the association between the variables. The research was ethically approved. Results: A statistical association was found between the age of the mother (0.0172), number of visits (<0.001) and presence of diseases (0.027) with low birth weight. Conclusion: Gestation and puerperium deserve to be incorporated by managers and health professionals as critical periods of life, since they require qualified and systematic attention in order to comply with the integrality of care and to prevent and control risk factors, especially modifiable ones., Objetivo: Avaliar fatores associados ao baixo peso ao nascer em maternidade de referência no Piauí. Método: Estudo descritivo transversal realizado em Teresina, entre novembro de 2018 e abril de 2019. A amostra foi de 385 puérperas. Utilizou-se de dados primários, por meio de entrevistas, e secundários. Para avaliação da associação entre as variáveis, utilizou-se o teste qui-quadrado e o teste exato de Fisher. A pesquisa foi aprovada eticamente. Resultados: Encontrou-se associação estatística entre idade da mãe (0,0172), número de consultas (<0,001) e presença de doenças (0,027) com o baixo peso ao nascer. Conclusão: Gestação e puerpério merecem ser incorporados por gestores e profissionais de saúde como períodos críticos de vida, pois requerem atenção qualificada e sistemática com vistas a cumprir com a integralidade do cuidado e à prevenção e controle de fatores de risco, especialmente, os modificáveis, Objetivo: Evaluar factores relacionados al bajo peso al nacer en maternidad referente en Piauí. Método: Estudio descriptivo transversal, realizado en Teresina, entre noviembre de 2018 y abril de 2019. La muestra fue de 385 puérperas. Se utilizó datos primarios, a través de entrevistas, y secundarios. Para evaluación de la relación entre las variables, se utilizó el test qui-quadrado y el test exacto de Fisher. La investigación fue aprobada éticamente. Resultados: Se encontró la relación estadística entre edad de la madre (0,0172), número de consultas (<0,001) y presencia de enfermedades (0,027) con el bajo peso al nacer. Conclusión: La ausencia de registros en la libreta de la gestante desafía a gestores y profesionales sanitarios. Gestación y puerperio merecen ser incorporados por los gestores y profesionales sanitarios como periodos críticos de vida, pues necesitan atención cualificada y sistemática con el objetivo de cumplir con la integralidad del cuidado y a la prevención y control de factores de riesgo, especialmente, los modificables.

Objective: To evaluate factors associated with low birth weight in a reference maternity in Piauí. Method: Descriptive cross-sectional study, carried out in Teresina between November 2018 and April 2019. The sample consisted of 385 postpartum women. Primary data were used, through interviews, and secondary data. The chisquare test and Fisher's Exact test wer used to assess the association between the variables. The research was ethically approved. Results: A statistical association was found between the age of the mother (0.0172), number of visits (<0.001) and presence of diseases (0.027) with low birth weight. Conclusion: Gestation and puerperium deserve to be incorporated by managers and health professionals as critical periods of life, since they require qualified and systematic attention in order to comply with the integrality of care and to prevent and control risk factors, especially modifiable ones., Objetivo: Avaliar fatores associados ao baixo peso ao nascer em maternidade de referência no Piauí. Método: Estudo descritivo transversal realizado em Teresina, entre novembro de 2018 e abril de 2019. A amostra foi de 385 puérperas. Utilizou-se de dados primários, por meio de entrevistas, e secundários. Para avaliação da associação entre as variáveis, utilizou-se o teste qui-quadrado e o teste exato de Fisher. A pesquisa foi aprovada eticamente. Resultados: Encontrou-se associação estatística entre idade da mãe (0,0172), número de consultas (<0,001) e presença de doenças (0,027) com o baixo peso ao nascer. Conclusão: Gestação e puerpério merecem ser incorporados por gestores e profissionais de saúde como períodos críticos de vida, pois requerem atenção qualificada e sistemática com vistas a cumprir com a integralidade do cuidado e à prevenção e controle de fatores de risco, especialmente, os modificáveis, Objetivo: Evaluar factores relacionados al bajo peso al nacer en maternidad referente en Piauí. Método: Estudio descriptivo transversal, realizado en Teresina, entre noviembre de 2018 y abril de 2019. La muestra fue de 385 puérperas. Se utilizó datos primarios, a través de entrevistas, y secundarios. Para evaluación de la relación entre las variables, se utilizó el test qui-quadrado y el test exacto de Fisher. La investigación fue aprobada éticamente. Resultados: Se encontró la relación estadística entre edad de la madre (0,0172), número de consultas (<0,001) y presencia de enfermedades (0,027) con el bajo peso al nacer. Conclusión: La ausencia de registros en la libreta de la gestante desafía a gestores y profesionales sanitarios. Gestación y puerperio merecen ser incorporados por los gestores y profesionales sanitarios como periodos críticos de vida, pues necesitan atención cualificada y sistemática con el objetivo de cumplir con la integralidad del cuidado y a la prevención y control de factores de riesgo, especialmente, los modificables.

Aims: To conduct an integrative review of published studies on the nutritional status of adults and the elderly and the factors related to it. Method: This is an integrative review carried out in the databases: LILACS and SCIELO, in Portuguese, using the indexers: nutritional status, nutritional surveys, nutritional assessment, adults and the elderly. Results: There was a high prevalence of individuals with overweight and the factors positively associated, in most studies, were sociodemographic. Overweight, in adults, was found in all income groups, marital status as an indicator for women and the upper economic class for men. In the elderly, the factors associated with an inactive occupational situation and residents of the urban area were observed. Conclusion: we identified an increasing prevalence of disorders in nutritional status among adults and the elderly, with excess weight showing a more significant growth than obesity., Objetivo: Realizar uma revisão integrativa de estudos publicados acerca do estado nutricional de adultos e idosos e os fatores a ele relacionados. Método: Trata-se de uma revisão integrativa realizada nas bases de dados: LILACS e SCIELO, em língua portuguesa, usando os indexadores: estado nutricional, inquéritos nutricionais, avaliação nutricional, adultos e idosos. Resultados: Constatou-se elevada prevalência de indivíduos com excesso de peso e os fatores positivamente associados, na maioria dos estudos, foram os sociodemográficos. O excesso de peso, em adultos, foi encontrado em todos os grupos de renda, o estado civil como indicador para as mulheres e a classe econômica alta para os homens. Já nos idosos os fatores associados a situação ocupacional inativa e residentes da zona urbana. Conclusão: identificamos prevalência crescente dos distúrbios no estado nutricional entre os adultos e idosos, com o excesso de peso apresentando um crescimento mais significativo do que a obesidade., Objetivo: Realizar una revisión integradora de los estudios publicados sobre el estado nutricional de adultos y ancianos y los factores relacionados con él. Método: Se trata de una revisión integradora realizada en las bases de datos: LILACS y SCIELO, en portugués, utilizando los indexadores: estado nutricional, encuestas nutricionales, valoración nutricional, adultos y ancianos. Resultados: Hubo una alta prevalencia de individuos con sobrepeso y los factores asociados positivamente, en la mayoría de los estudios, fueron sociodemográficos. El sobrepeso, en adultos, se encontró en todos los grupos de ingresos, el estado civil como indicador para las mujeres y la clase económica alta para los hombres. En los ancianos, los factores asociados a una situación ocupacional inactiva y residentes del área urbana, por otro lado. Conclusión: identificamos una prevalencia creciente de trastornos en el estado nutricional entre adultos y ancianos, mostrando el exceso de peso un crecimiento más significativo que la obesidad.

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

Aims: To conduct an integrative review of published studies on the nutritional status of adults and the elderly and the factors related to it. Method: This is an integrative review carried out in the databases: LILACS and SCIELO, in Portuguese, using the indexers: nutritional status, nutritional surveys, nutritional assessment, adults and the elderly. Results: There was a high prevalence of individuals with overweight and the factors positively associated, in most studies, were sociodemographic. Overweight, in adults, was found in all income groups, marital status as an indicator for women and the upper economic class for men. In the elderly, the factors associated with an inactive occupational situation and residents of the urban area were observed. Conclusion: we identified an increasing prevalence of disorders in nutritional status among adults and the elderly, with excess weight showing a more significant growth than obesity., Objetivo: Realizar uma revisão integrativa de estudos publicados acerca do estado nutricional de adultos e idosos e os fatores a ele relacionados. Método: Trata-se de uma revisão integrativa realizada nas bases de dados: LILACS e SCIELO, em língua portuguesa, usando os indexadores: estado nutricional, inquéritos nutricionais, avaliação nutricional, adultos e idosos. Resultados: Constatou-se elevada prevalência de indivíduos com excesso de peso e os fatores positivamente associados, na maioria dos estudos, foram os sociodemográficos. O excesso de peso, em adultos, foi encontrado em todos os grupos de renda, o estado civil como indicador para as mulheres e a classe econômica alta para os homens. Já nos idosos os fatores associados a situação ocupacional inativa e residentes da zona urbana. Conclusão: identificamos prevalência crescente dos distúrbios no estado nutricional entre os adultos e idosos, com o excesso de peso apresentando um crescimento mais significativo do que a obesidade., Objetivo: Realizar una revisión integradora de los estudios publicados sobre el estado nutricional de adultos y ancianos y los factores relacionados con él. Método: Se trata de una revisión integradora realizada en las bases de datos: LILACS y SCIELO, en portugués, utilizando los indexadores: estado nutricional, encuestas nutricionales, valoración nutricional, adultos y ancianos. Resultados: Hubo una alta prevalencia de individuos con sobrepeso y los factores asociados positivamente, en la mayoría de los estudios, fueron sociodemográficos. El sobrepeso, en adultos, se encontró en todos los grupos de ingresos, el estado civil como indicador para las mujeres y la clase económica alta para los hombres. En los ancianos, los factores asociados a una situación ocupacional inactiva y residentes del área urbana, por otro lado. Conclusión: identificamos una prevalencia creciente de trastornos en el estado nutricional entre adultos y ancianos, mostrando el exceso de peso un crecimiento más significativo que la obesidad.

Objective: To evaluate factors associated with low birth weight in a reference maternity in Piauí. Method: Descriptive cross-sectional study, carried out in Teresina between November 2018 and April 2019. The sample consisted of 385 postpartum women. Primary data were used, through interviews, and secondary data. The chisquare test and Fisher's Exact test wer used to assess the association between the variables. The research was ethically approved. Results: A statistical association was found between the age of the mother (0.0172), number of visits (<0.001) and presence of diseases (0.027) with low birth weight. Conclusion: Gestation and puerperium deserve to be incorporated by managers and health professionals as critical periods of life, since they require qualified and systematic attention in order to comply with the integrality of care and to prevent and control risk factors, especially modifiable ones., Objetivo: Avaliar fatores associados ao baixo peso ao nascer em maternidade de referência no Piauí. Método: Estudo descritivo transversal realizado em Teresina, entre novembro de 2018 e abril de 2019. A amostra foi de 385 puérperas. Utilizou-se de dados primários, por meio de entrevistas, e secundários. Para avaliação da associação entre as variáveis, utilizou-se o teste qui-quadrado e o teste exato de Fisher. A pesquisa foi aprovada eticamente. Resultados: Encontrou-se associação estatística entre idade da mãe (0,0172), número de consultas (<0,001) e presença de doenças (0,027) com o baixo peso ao nascer. Conclusão: Gestação e puerpério merecem ser incorporados por gestores e profissionais de saúde como períodos críticos de vida, pois requerem atenção qualificada e sistemática com vistas a cumprir com a integralidade do cuidado e à prevenção e controle de fatores de risco, especialmente, os modificáveis, Objetivo: Evaluar factores relacionados al bajo peso al nacer en maternidad referente en Piauí. Método: Estudio descriptivo transversal, realizado en Teresina, entre noviembre de 2018 y abril de 2019. La muestra fue de 385 puérperas. Se utilizó datos primarios, a través de entrevistas, y secundarios. Para evaluación de la relación entre las variables, se utilizó el test qui-quadrado y el test exacto de Fisher. La investigación fue aprobada éticamente. Resultados: Se encontró la relación estadística entre edad de la madre (0,0172), número de consultas (<0,001) y presencia de enfermedades (0,027) con el bajo peso al nacer. Conclusión: La ausencia de registros en la libreta de la gestante desafía a gestores y profesionales sanitarios. Gestación y puerperio merecen ser incorporados por los gestores y profesionales sanitarios como periodos críticos de vida, pues necesitan atención cualificada y sistemática con el objetivo de cumplir con la integralidad del cuidado y a la prevención y control de factores de riesgo, especialmente, los modificables.

Aims: To conduct an integrative review of published studies on the nutritional status of adults and the elderly and the factors related to it. Method: This is an integrative review carried out in the databases: LILACS and SCIELO, in Portuguese, using the indexers: nutritional status, nutritional surveys, nutritional assessment, adults and the elderly. Results: There was a high prevalence of individuals with overweight and the factors positively associated, in most studies, were sociodemographic. Overweight, in adults, was found in all income groups, marital status as an indicator for women and the upper economic class for men. In the elderly, the factors associated with an inactive occupational situation and residents of the urban area were observed. Conclusion: we identified an increasing prevalence of disorders in nutritional status among adults and the elderly, with excess weight showing a more significant growth than obesity., Objetivo: Realizar uma revisão integrativa de estudos publicados acerca do estado nutricional de adultos e idosos e os fatores a ele relacionados. Método: Trata-se de uma revisão integrativa realizada nas bases de dados: LILACS e SCIELO, em língua portuguesa, usando os indexadores: estado nutricional, inquéritos nutricionais, avaliação nutricional, adultos e idosos. Resultados: Constatou-se elevada prevalência de indivíduos com excesso de peso e os fatores positivamente associados, na maioria dos estudos, foram os sociodemográficos. O excesso de peso, em adultos, foi encontrado em todos os grupos de renda, o estado civil como indicador para as mulheres e a classe econômica alta para os homens. Já nos idosos os fatores associados a situação ocupacional inativa e residentes da zona urbana. Conclusão: identificamos prevalência crescente dos distúrbios no estado nutricional entre os adultos e idosos, com o excesso de peso apresentando um crescimento mais significativo do que a obesidade., Objetivo: Realizar una revisión integradora de los estudios publicados sobre el estado nutricional de adultos y ancianos y los factores relacionados con él. Método: Se trata de una revisión integradora realizada en las bases de datos: LILACS y SCIELO, en portugués, utilizando los indexadores: estado nutricional, encuestas nutricionales, valoración nutricional, adultos y ancianos. Resultados: Hubo una alta prevalencia de individuos con sobrepeso y los factores asociados positivamente, en la mayoría de los estudios, fueron sociodemográficos. El sobrepeso, en adultos, se encontró en todos los grupos de ingresos, el estado civil como indicador para las mujeres y la clase económica alta para los hombres. En los ancianos, los factores asociados a una situación ocupacional inactiva y residentes del área urbana, por otro lado. Conclusión: identificamos una prevalencia creciente de trastornos en el estado nutricional entre adultos y ancianos, mostrando el exceso de peso un crecimiento más significativo que la obesidad.

Objective: To evaluate factors associated with low birth weight in a reference maternity in Piauí. Method: Descriptive cross-sectional study, carried out in Teresina between November 2018 and April 2019. The sample consisted of 385 postpartum women. Primary data were used, through interviews, and secondary data. The chisquare test and Fisher's Exact test wer used to assess the association between the variables. The research was ethically approved. Results: A statistical association was found between the age of the mother (0.0172), number of visits (<0.001) and presence of diseases (0.027) with low birth weight. Conclusion: Gestation and puerperium deserve to be incorporated by managers and health professionals as critical periods of life, since they require qualified and systematic attention in order to comply with the integrality of care and to prevent and control risk factors, especially modifiable ones., Objetivo: Avaliar fatores associados ao baixo peso ao nascer em maternidade de referência no Piauí. Método: Estudo descritivo transversal realizado em Teresina, entre novembro de 2018 e abril de 2019. A amostra foi de 385 puérperas. Utilizou-se de dados primários, por meio de entrevistas, e secundários. Para avaliação da associação entre as variáveis, utilizou-se o teste qui-quadrado e o teste exato de Fisher. A pesquisa foi aprovada eticamente. Resultados: Encontrou-se associação estatística entre idade da mãe (0,0172), número de consultas (<0,001) e presença de doenças (0,027) com o baixo peso ao nascer. Conclusão: Gestação e puerpério merecem ser incorporados por gestores e profissionais de saúde como períodos críticos de vida, pois requerem atenção qualificada e sistemática com vistas a cumprir com a integralidade do cuidado e à prevenção e controle de fatores de risco, especialmente, os modificáveis, Objetivo: Evaluar factores relacionados al bajo peso al nacer en maternidad referente en Piauí. Método: Estudio descriptivo transversal, realizado en Teresina, entre noviembre de 2018 y abril de 2019. La muestra fue de 385 puérperas. Se utilizó datos primarios, a través de entrevistas, y secundarios. Para evaluación de la relación entre las variables, se utilizó el test qui-quadrado y el test exacto de Fisher. La investigación fue aprobada éticamente. Resultados: Se encontró la relación estadística entre edad de la madre (0,0172), número de consultas (<0,001) y presencia de enfermedades (0,027) con el bajo peso al nacer. Conclusión: La ausencia de registros en la libreta de la gestante desafía a gestores y profesionales sanitarios. Gestación y puerperio merecen ser incorporados por los gestores y profesionales sanitarios como periodos críticos de vida, pues necesitan atención cualificada y sistemática con el objetivo de cumplir con la integralidad del cuidado y a la prevención y control de factores de riesgo, especialmente, los modificables.

Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highl

Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highl

Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highl

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

Objective: To evaluate factors associated with low birth weight in a reference maternity in Piauí. Method: Descriptive cross-sectional study, carried out in Teresina between November 2018 and April 2019. The sample consisted of 385 postpartum women. Primary data were used, through interviews, and secondary data. The chisquare test and Fisher's Exact test wer used to assess the association between the variables. The research was ethically approved. Results: A statistical association was found between the age of the mother (0.0172), number of visits (<0.001) and presence of diseases (0.027) with low birth weight. Conclusion: Gestation and puerperium deserve to be incorporated by managers and health professionals as critical periods of life, since they require qualified and systematic attention in order to comply with the integrality of care and to prevent and control risk factors, especially modifiable ones., Objetivo: Avaliar fatores associados ao baixo peso ao nascer em maternidade de referência no Piauí. Método: Estudo descritivo transversal realizado em Teresina, entre novembro de 2018 e abril de 2019. A amostra foi de 385 puérperas. Utilizou-se de dados primários, por meio de entrevistas, e secundários. Para avaliação da associação entre as variáveis, utilizou-se o teste qui-quadrado e o teste exato de Fisher. A pesquisa foi aprovada eticamente. Resultados: Encontrou-se associação estatística entre idade da mãe (0,0172), número de consultas (<0,001) e presença de doenças (0,027) com o baixo peso ao nascer. Conclusão: Gestação e puerpério merecem ser incorporados por gestores e profissionais de saúde como períodos críticos de vida, pois requerem atenção qualificada e sistemática com vistas a cumprir com a integralidade do cuidado e à prevenção e controle de fatores de risco, especialmente, os modificáveis, Objetivo: Evaluar factores relacionados al bajo peso al nacer en maternidad referente en Piauí. Método: Estudio descriptivo transversal, realizado en Teresina, entre noviembre de 2018 y abril de 2019. La muestra fue de 385 puérperas. Se utilizó datos primarios, a través de entrevistas, y secundarios. Para evaluación de la relación entre las variables, se utilizó el test qui-quadrado y el test exacto de Fisher. La investigación fue aprobada éticamente. Resultados: Se encontró la relación estadística entre edad de la madre (0,0172), número de consultas (<0,001) y presencia de enfermedades (0,027) con el bajo peso al nacer. Conclusión: La ausencia de registros en la libreta de la gestante desafía a gestores y profesionales sanitarios. Gestación y puerperio merecen ser incorporados por los gestores y profesionales sanitarios como periodos críticos de vida, pues necesitan atención cualificada y sistemática con el objetivo de cumplir con la integralidad del cuidado y a la prevención y control de factores de riesgo, especialmente, los modificables.

Aims: To conduct an integrative review of published studies on the nutritional status of adults and the elderly and the factors related to it. Method: This is an integrative review carried out in the databases: LILACS and SCIELO, in Portuguese, using the indexers: nutritional status, nutritional surveys, nutritional assessment, adults and the elderly. Results: There was a high prevalence of individuals with overweight and the factors positively associated, in most studies, were sociodemographic. Overweight, in adults, was found in all income groups, marital status as an indicator for women and the upper economic class for men. In the elderly, the factors associated with an inactive occupational situation and residents of the urban area were observed. Conclusion: we identified an increasing prevalence of disorders in nutritional status among adults and the elderly, with excess weight showing a more significant growth than obesity., Objetivo: Realizar uma revisão integrativa de estudos publicados acerca do estado nutricional de adultos e idosos e os fatores a ele relacionados. Método: Trata-se de uma revisão integrativa realizada nas bases de dados: LILACS e SCIELO, em língua portuguesa, usando os indexadores: estado nutricional, inquéritos nutricionais, avaliação nutricional, adultos e idosos. Resultados: Constatou-se elevada prevalência de indivíduos com excesso de peso e os fatores positivamente associados, na maioria dos estudos, foram os sociodemográficos. O excesso de peso, em adultos, foi encontrado em todos os grupos de renda, o estado civil como indicador para as mulheres e a classe econômica alta para os homens. Já nos idosos os fatores associados a situação ocupacional inativa e residentes da zona urbana. Conclusão: identificamos prevalência crescente dos distúrbios no estado nutricional entre os adultos e idosos, com o excesso de peso apresentando um crescimento mais significativo do que a obesidade., Objetivo: Realizar una revisión integradora de los estudios publicados sobre el estado nutricional de adultos y ancianos y los factores relacionados con él. Método: Se trata de una revisión integradora realizada en las bases de datos: LILACS y SCIELO, en portugués, utilizando los indexadores: estado nutricional, encuestas nutricionales, valoración nutricional, adultos y ancianos. Resultados: Hubo una alta prevalencia de individuos con sobrepeso y los factores asociados positivamente, en la mayoría de los estudios, fueron sociodemográficos. El sobrepeso, en adultos, se encontró en todos los grupos de ingresos, el estado civil como indicador para las mujeres y la clase económica alta para los hombres. En los ancianos, los factores asociados a una situación ocupacional inactiva y residentes del área urbana, por otro lado. Conclusión: identificamos una prevalencia creciente de trastornos en el estado nutricional entre adultos y ancianos, mostrando el exceso de peso un crecimiento más significativo que la obesidad.

The leukocyte-specific ß2-integrin LFA-1 and its ligand ICAM-1, expressed on endothelial cells (ECs), are involved in the arrest, adhesion, and transendothelial migration of leukocytes. Although the role of mechanical forces on LFA-1 activation is well established, the impact of forces on its major ligand ICAM-1 has received less attention. Using a parallel-plate flow chamber combined with confocal and super-resolution microscopy, we show that prolonged shear flow induces global translocation of ICAM-1 on ECs upstream of flow direction. Interestingly, shear forces caused actin rearrangements and promoted actin-dependent ICAM-1 nanoclustering before LFA-1 engagement. T cells adhered to mechanically prestimulated ECs or nanoclustered ICAM-1 substrates developed a promigratory phenotype, migrated faster, and exhibited shorter-lived interactions with ECs than when adhered to non mechanically stimulated ECs or to monomeric ICAM-1 substrates. Together, our results indicate that shear forces increase ICAM-1/LFA-1 bonds because of ICAM-1 nanoclustering, strengthening adhesion and allowing cells to exert higher traction forces required for faster migration. Our data also underscore the importance of mechanical forces regulating the nanoscale organization of membrane receptors and their contribution to cell adhesion regulation., The authors thank T. van Zanten, E. Gutierrez and F. Campelo for useful discussions, J. Andilla from the SLN facility at ICFO for his support with STED imaging, and M. Rivas for technical assistance. This work was supported by the Human Frontiers Science Program (HFSP) (GA RGP0027/2012) and European Union H2020 Framework Programme under European Research Council Grant 788546 – NANO-MEMEC. M.F.G.-P. acknowledges support from the Government of Spain (FIS2017-89560-R; Severo Ochoa CEX2019-000910-S), Fundació Cellex, Fundació Mir-Puig, and Generalitat de Catalunya (CERCA, AGAUR Grant No. 2017SGR1000). I.K.P. acknowledges the support of the Grant No. POIR.04.04.00-00-3F2E/17- 00 which is carried out within the HOMING program of the Foundation for Polish Science co- financed by the European Union under the European Regional Development Fund. C.M. gratefully acknowledges funding from FEDER/Ministerio de Ciencia, Innovació n y Universidades – Agencia Estatal de Investigació n through the “Ramón y Cajal” program 2015 (Grant No. RYC-2015-17896), and the “Programa Estatal de I+D+i Orientada a los Retos de la 22 Sociedad” (Grant No. BFU2017-85693-R); from the Generalitat de Catalunya (AGAUR Grant No. 2017SGR940). The authors declare no competing or financial interests., Peer Reviewed, Postprint (author's final draft)

Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highl

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support. Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use. Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app =30 days was used as the cut-off for higher app use. Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently

Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support. Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use. Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app =30 days was used as the cut-off for higher app use. Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently

Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highl

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.

This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. The centrepiece of this article is the requirements section, comprising definitions; multidisciplinary structure; minimum case, procedure and staffing volumes; and detailed descriptions of the skills of, and resources needed by, members and specialisms in the multidisciplinary team in a breast centre. These requirements are positioned within narrative on European breast cancer epidemiology, the standard of care, challenges to delivering this standard, and supporting evidence, to enable a broad audience to appreciate the importance of establishing these requirements in specialist breast centres.

This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. The centrepiece of this article is the requirements section, comprising definitions; multidisciplinary structure; minimum case, procedure and staffing volumes; and detailed descriptions of the skills of, and resources needed by, members and specialisms in the multidisciplinary team in a breast centre. These requirements are positioned within narrative on European breast cancer epidemiology, the standard of care, challenges to delivering this standard, and supporting evidence, to enable a broad audience to appreciate the importance of establishing these requirements in specialist breast centres.

This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. The centrepiece of this article is the requirements section, comprising definitions; multidisciplinary structure; minimum case, procedure and staffing volumes; and detailed descriptions of the skills of, and resources needed by, members and specialisms in the multidisciplinary team in a breast centre. These requirements are positioned within narrative on European breast cancer epidemiology, the standard of care, challenges to delivering this standard, and supporting evidence, to enable a broad audience to appreciate the importance of establishing these requirements in specialist breast centres.

This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. The centrepiece of this article is the requirements section, comprising definitions; multidisciplinary structure; minimum case, procedure and staffing volumes; and detailed descriptions of the skills of, and resources needed by, members and specialisms in the multidisciplinary team in a breast centre. These requirements are positioned within narrative on European breast cancer epidemiology, the standard of care, challenges to delivering this standard, and supporting evidence, to enable a broad audience to appreciate the importance of establishing these requirements in specialist breast centres.

This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. The centrepiece of this article is the requirements section, comprising definitions; multidisciplinary structure; minimum case, procedure and staffing volumes; and detailed descriptions of the skills of, and resources needed by, members and specialisms in the multidisciplinary team in a breast centre. These requirements are positioned within narrative on European breast cancer epidemiology, the standard of care, challenges to delivering this standard, and supporting evidence, to enable a broad audience to appreciate the importance of establishing these requirements in specialist breast centres.

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Lung cancer is the leading cause of cancer mortality and has a wide variation in treatment and outcomes in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must only be carried out in lung cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship., SCOPUS: re.j, info:eu-repo/semantics/published

Family farming holds the promise of adopting agricultural practices and contributing to food and nutritional sovereignty and security. Farmers' health is conditioned by social, economic, technological and organizational factors related to the production and consumption profile, as well as the physical, chemical, biological, mechanical and ergonomic risks present in work processes. The objective is to characterize the health and nutrition profile of rural family farmers in Teresina – Piauí, from the perspective of identifying and preventing possible risks in the group. Methodology: Descriptive and cross-sectional case study conducted in a rural Teresina area. Family farmers of both genders, aged over 20 years, who had been working in the garden for at least four months, participated. For data collection, an interview was conducted, which involved socioeconomic aspects, lifestyle, self-reported health status, food intake assessment and anthropometry. Data were processed in the Spreadsheet Program and presented with descriptive statistics. The study was approved by the Ethics Committee of Uninovafapi (No. 2,534,540). Twenty family farmers participated in the survey. Of these, they were 50% of each sex, most of them perceived to be brown and were aged between 40 and 59 years. As for health conditions, just over half considered their health status from poor to regular and did not practice physical activity; low prevalence of smokers. About working time in the garden, it varied from 01 to 20 years. Most considered the working conditions good/great and all reported being satisfied / very satisfied working in this area. The most prevalent nutritional status among adult farmers was overweight, being higher among men. In the elderly, the higher prevalence was identified in women. The high risk for metabolic and cardiovascular diseases was present in both age groups, being higher among the elderly; The very high risk was identified only in adult women. Regarding food consumpti, La agricultura familiar promete adoptar prácticas agrícolas y contribuir a la soberanía y seguridad alimentaria y nutricional. La salud de los agricultores está condicionada por factores sociales, económicos, tecnológicos y organizativos relacionados con el perfil de producción y consumo, así como por los riesgos físicos, químicos, biológicos, mecánicos y ergonómicos presentes en los procesos de trabajo. Tiene como objetivo caracterizar el perfil de salud y nutrición de los agricultores familiares en Teresina - PI, desde la perspectiva de identificar y prevenir posibles riesgos en el grupo. La Metodología utilizada fue el estudio de caso descriptivo y transversal realizado en una zona rural de Teresina. Participaron agricultores familiares de ambos sexos, mayores de 20 años, que habían trabajado en el campo durante al menos cuatro meses. Para la recopilación de datos, se realizó una entrevista que incluyó aspectos socioeconómicos, estilo de vida, estado de salud autoinformado, evaluación de la ingesta de alimentos y antropometría. La investigación fue aprobada por el Comité de Ética de Uninovafapi (nº 2.534.540). Veinte agricultores familiares participaron en la encuesta, 50% de cada sexo, la mayoría de ellos percibidos como marrones y tenían entre 40 y 59 años. En cuanto a las condiciones de salud, poco más de la mitad consideró su estado de salud de pobre a regular y no practicó actividad física, teniendo también baja prevalencia de fumadores. Sobre el tiempo de trabajo en el campo, varió de 01 a 20 años. La mayoría consideró que las condiciones de trabajo eran buenas / excelentes y todos informaron que estaban satisfechos / muy satisfechos trabajando en esta área. El estado nutricional más frecuente entre los agricultores adultos fue el sobrepeso, siendo mayor entre los hombres. En los ancianos, la mayor prevalencia se identificó en las mujeres. El alto riesgo de enfermedades metabólicas y cardiovasculares estuvo presente en ambos grupos de edad, siendo mayor ent, A agricultura familiar carrega a promessa de adotar práticas agrícolas e contribuir para a soberania e segurança alimentar e nutricional. A saúde dos agricultores é condicionada por fatores sociais, econômicos, tecnológicos e organizacionais relacionados ao perfil de produção e consumo, além dos riscos de natureza físicos, químicos, biológicos, mecânicos e ergonômicos presentes nos processos de trabalho. Objetiva caracterizar o perfil de saúde e nutrição de agricultores familiares de Teresina – PI, na perspectiva de identificar e prevenir possíveis riscos no grupo. A Metodologia consiste de um estudo de caso descritivo e transversal, realizado em uma zona rural de Teresina. Participaram agricultores familiares de ambos os gêneros, com idade acima de 20 anos, que trabalhavam na horta há, pelo menos, quatro meses. Para a coleta de dados realizou-se entrevista, que envolveu aspectos socioeconômicos, estilo de vida, situação de saúde autor referida, avaliação do consumo alimentar e antropometria. A pesquisa foi aprovada pelo Comitê de Ética do Uninovafapi (nº 2.534.540). Participaram 20 agricultores familiares, 50% de cada sexo, a maioria percebiam-se de cor parda e tinham idade entre 40 a 59 anos. Quanto às condições de saúde, pouco mais da metade consideraram o estado de saúde de ruim a regular e não praticavam atividade física; pouca prevalência de fumantes. Sobre o tempo de trabalho na horta, variou de 01 a 20 anos. A maior parte consideraram as condições de trabalho de boa/ótima e, todos referiram estar satisfeitos/muito satisfeitos trabalhando nessa área. O estado nutricional mais prevalente entre os agricultores adultos foi o excesso de peso, sendo maior entre os homens. Já nos idosos, foi identificada a prevalência maior nas mulheres. O risco elevado para doenças metabólicas e cardiovasculares estava presente em ambas faixas etárias, sendo maior entre os idosos; o risco muito elevado foi identificado apenas nas mulheres adultas. Em relação ao consumo alimentar

Objetivou-se analisar o conhecimento dos profissionais da Estratégia Saúde da Família sobre o aleitamento materno e alimentação complementar saudável. Pesquisa quantitativa e transversal, amostra por conveniência realizada com 50 profissionais da Estratégia Saúde da Família em seis Unidades Básicas de Saúde da zona leste/sudeste de Teresina-PI. Aplicou-se um questionário estruturado em duas partes: caracterização sócio profissional e conhecimentos com relação ao aleitamento materno e alimentação complementar. Os dados foram agrupados e analisados por média simples. 90% dos profissionais recomendam até seis meses de idade o aleitamento materno exclusivo, 84% afirmam que a amamentação é sob livre demanda, 72% desaconselham o uso de chupeta e 64% souberam identificar os sinais adequados da boa pega. Com relação à alimentação complementar o feijão e a repetição do alimento são poucos estimulados. Os profissionais têm um conhecimento adequado sobre o aleitamento materno exclusivo, no entanto, precisam melhorar suas orientações quanto a alimentação complementar.

Objetivou-se analisar o conhecimento dos profissionais da Estratégia Saúde da Família sobre o aleitamento materno e alimentação complementar saudável. Pesquisa quantitativa e transversal, amostra por conveniência realizada com 50 profissionais da Estratégia Saúde da Família em seis Unidades Básicas de Saúde da zona leste/sudeste de Teresina-PI. Aplicou-se um questionário estruturado em duas partes: caracterização sócio profissional e conhecimentos com relação ao aleitamento materno e alimentação complementar. Os dados foram agrupados e analisados por média simples. 90% dos profissionais recomendam até seis meses de idade o aleitamento materno exclusivo, 84% afirmam que a amamentação é sob livre demanda, 72% desaconselham o uso de chupeta e 64% souberam identificar os sinais adequados da boa pega. Com relação à alimentação complementar o feijão e a repetição do alimento são poucos estimulados. Os profissionais têm um conhecimento adequado sobre o aleitamento materno exclusivo, no entanto, precisam melhorar suas orientações quanto a alimentação complementar.

Objetivou-se analisar o conhecimento dos profissionais da Estratégia Saúde da Família sobre o aleitamento materno e alimentação complementar saudável. Pesquisa quantitativa e transversal, amostra por conveniência realizada com 50 profissionais da Estratégia Saúde da Família em seis Unidades Básicas de Saúde da zona leste/sudeste de Teresina-PI. Aplicou-se um questionário estruturado em duas partes: caracterização sócio profissional e conhecimentos com relação ao aleitamento materno e alimentação complementar. Os dados foram agrupados e analisados por média simples. 90% dos profissionais recomendam até seis meses de idade o aleitamento materno exclusivo, 84% afirmam que a amamentação é sob livre demanda, 72% desaconselham o uso de chupeta e 64% souberam identificar os sinais adequados da boa pega. Com relação à alimentação complementar o feijão e a repetição do alimento são poucos estimulados. Os profissionais têm um conhecimento adequado sobre o aleitamento materno exclusivo, no entanto, precisam melhorar suas orientações quanto a alimentação complementar.

Objetivou-se analisar o conhecimento dos profissionais da Estratégia Saúde da Família sobre o aleitamento materno e alimentação complementar saudável. Pesquisa quantitativa e transversal, amostra por conveniência realizada com 50 profissionais da Estratégia Saúde da Família em seis Unidades Básicas de Saúde da zona leste/sudeste de Teresina-PI. Aplicou-se um questionário estruturado em duas partes: caracterização sócio profissional e conhecimentos com relação ao aleitamento materno e alimentação complementar. Os dados foram agrupados e analisados por média simples. 90% dos profissionais recomendam até seis meses de idade o aleitamento materno exclusivo, 84% afirmam que a amamentação é sob livre demanda, 72% desaconselham o uso de chupeta e 64% souberam identificar os sinais adequados da boa pega. Com relação à alimentação complementar o feijão e a repetição do alimento são poucos estimulados. Os profissionais têm um conhecimento adequado sobre o aleitamento materno exclusivo, no entanto, precisam melhorar suas orientações quanto a alimentação complementar.

Objetivou-se analisar o conhecimento dos profissionais da Estratégia Saúde da Família sobre o aleitamento materno e alimentação complementar saudável. Pesquisa quantitativa e transversal, amostra por conveniência realizada com 50 profissionais da Estratégia Saúde da Família em seis Unidades Básicas de Saúde da zona leste/sudeste de Teresina-PI. Aplicou-se um questionário estruturado em duas partes: caracterização sócio profissional e conhecimentos com relação ao aleitamento materno e alimentação complementar. Os dados foram agrupados e analisados por média simples. 90% dos profissionais recomendam até seis meses de idade o aleitamento materno exclusivo, 84% afirmam que a amamentação é sob livre demanda, 72% desaconselham o uso de chupeta e 64% souberam identificar os sinais adequados da boa pega. Com relação à alimentação complementar o feijão e a repetição do alimento são poucos estimulados. Os profissionais têm um conhecimento adequado sobre o aleitamento materno exclusivo, no entanto, precisam melhorar suas orientações quanto a alimentação complementar.

Tumors have aberrant proteomes that often do not match their corresponding transcriptome profiles. One possible cause of this discrepancy is the existence of aberrant RNA modification landscapes in the so-called epitranscriptome. Here, we report that human glioma cells undergo DNA methylation-associated epigenetic silencing of NSUN5, a candidate RNA methyltransferase for 5-methylcytosine. In this setting, NSUN5 exhibits tumor-suppressor characteristics in vivo glioma models. We also found that NSUN5 loss generates an unmethylated status at the C3782 position of 28S rRNA that drives an overall depletion of protein synthesis, and leads to the emergence of an adaptive translational program for survival under conditions of cellular stress. Interestingly, NSUN5 epigenetic inactivation also renders these gliomas sensitive to bioactivatable substrates of the stress-related enzyme NQO1. Most importantly, NSUN5 epigenetic inactivation is a hallmark of glioma patients with long-term survival for this otherwise devastating disease.

Our research team previously developed an accelerometry-based device, which can be worn on the waist during daily life activities and detects the occurrence of dyskinesia in patients with Parkinson’s disease. The goal of this study was to analyze the magnitude of correlation between the numeric output of the device algorithm and the results of the Unified Dyskinesia Rating Scale (UDysRS), administered by a physician. In this study, 13 Parkinson’s patients, who were symptomatic with dyskinesias, were monitored with the device at home, for an average period of 30¿minutes, while performing normal daily life activities. Each patient’s activity was simultaneously video-recorded. A physician was in charge of reviewing the recorded videos and determining the severity of dyskinesia through the UDysRS for every patient. The sensor device yielded only one value for dyskinesia severity, which was calculated by averaging the recorded device readings. Correlation between the results of physician’s assessment and the sensor output was analyzed with the Spearman’s correlation coefficient. The correlation coefficient between the sensor output and UDysRS result was 0.70 (CI 95%: 0.33–0.88; p¿=¿0.01). Since the sensor was located on the waist, the correlation between the sensor output and the results of the trunk and legs scale sub-items was calculated: 0.91 (CI 95% 0.76–0.97: p¿<¿0.001). The conclusion is that the magnitude of dyskinesia, as measured by the tested device, presented good correlation with that observed by a physician., Postprint (published version)

Time traces obtained from a variety of biophysical experiments contain valuable information on underlying processes occurring at the molecular level. Accurate quantification of these data can help explain the details of the complex dynamics of biological systems. Here, we describe PLANT (Piecewise Linear Approximation of Noisy Trajectories), a segmentation algorithm that allows the reconstruction of time-trace data with constant noise as consecutive straight lines, from which changes of slopes and their respective durations can be extracted. We present a general description of the algorithm and perform extensive simulations to characterize its strengths and limitations, providing a rationale for the performance of the algorithm in the different conditions tested. We further apply the algorithm to experimental data obtained from tracking the centroid position of lymphocytes migrating under the effect of a laminar flow and from single myosin molecules interacting with actin in a dual-trap force-clamp configuration., The authors gratefully acknowledge financial support fromthe European Commission (FP7-ICT-2011-7, grant number 288263), Erasmus Mundus Doctorate Program Europhoton-ics (grant number 159224-1-2009-1-FR-ERA MUNDUS-EMJD), Spanish Ministry of Economy and Competi-tiveness (“Severo Ochoa” Programme for Centres of Excellence in Research & Development SEV-2015-0522,and FIS2014-56107-R grants), Generalitat de Catalunyathrough the CERCA program, Italian Ministry of Uni-versity and Research (FIRB “Futuro in Ricerca” 2013grant n. RBFR13V4M2 and Flagship Project NANOMAX),Fundaci ́o Privada CELLEX (Barcelona), Ente Cassa diRisparmio di Firenze, Human Frontier Science Program (GARGP0027/2012) and LaserLab Europe 4 (GA 654148). C.M.acknowledges funding from the Spanish Ministry of Econ-omy and Competitiveness (MINECO) and the EuropeanSocial Fund (ESF) through the Ram ́on y Cajal program 2015(RYC-2015-17896)., Peer Reviewed, Postprint (author's final draft)

Background: ECCO essential requirements for quality cancer care (ERQCC) are explanations and descriptions of challenges, organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Melanoma: essential requirements for quality care: • Melanoma, the most-deadly skin cancer, is rising in incidence among fair-skinned people in Europe. Increasing complexity of care for advanced disease in clinical areas such as staging and new therapies requires attention to a number of challenges and inequalities in a diverse patient group.• Care for advanced melanoma must only be carried out in, or in collaboration with, specialist melanoma centres which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Access to such units is far from universal in all European countries.• It is essential that, to meet European aspirations for high-quality comprehensive cancer control, healthcare organisations implement the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis to treatment and follow-up, to improve survival and quality of life for patients.Conclusion: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for melanoma. The ERQCC expert group is aware that it is not possible to propose a ‘one size fits all’ system for all countries, but urges that access to multidisciplin, SCOPUS: re.j, info:eu-repo/semantics/published