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Abstract Diabetes poses a substantial disease burden, prompting preventive interventions. Physical inactivity, a major risk factor for type 2 diabetes, can potentially be mitigated by enhancing area-level walkability. Despite this, limited population-based studies have investigated the link between walkability and objective diabetes measures. Our study aims to estimate the association between area-level walkability and individual glycated haemoglobin levels in the Portuguese adult population without the diagnosis of diabetes. Data from the 2011 census and an updated street map were obtained to construct a walkability index based on residential density, land-use mix, and street connectivity. Individual health data were sourced from The National Health Examination Survey (INSEF) 2015, a representative survey of the Portuguese adult population. Gamma regression was employed for estimation of the main associations, revealing that residing in moderately walkable areas significantly reduced average glycated haemoglobin levels (Exp(β) = 0.906; 95% CI: 0.821, 0.999) compared to the least walkable areas. The association was less pronounced and not statistically significant for the third tertile of walkability (Exp(β) = 0.919; 95% CI: 0.822, 1.028). Our findings highlight a nonlinear protective association between walkability and glycated haemoglobin, emphasizing the potential policy implications for urban planning, diabetes prevention, and health promotion.

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Introduction: Acute pharyngitis is a common diagnosis in primary care. Although viruses are the most common aetiology, antibiotic therapy is frequently prescribed. The inappropriate antibiotic prescription should be avoided to prevent antibiotic resistance. Many national and international guidelines recommend testing for group A streptococcus (GAS) before antibiotic treatment when clinical presentation suggests GAS infection. Aim: This study aims to describe the feasibility of the implementation of the rapid antigen detection test (RADT) in a primary care setting and its impact on antibiotic prescription. Secondary goals include the evaluation of possible associations between symptoms and RADT results. Methods: From October 2019 to March 2020, patients presenting with acute pharyngitis at USF do Parque were eligible. A questionnaire was applied to divide the individuals into four different groups (clearly viral, probably viral, diagnostic doubt, and probably bacterial), and to assess the previous intention to prescribe antibiotics. We applied 136 questionnaires and performed 133 RADT. Nursing staff classified the specimen collection process and result from interpretation according to its difficulty. The proportion of antibiotics avoided was estimated as the number of times physicians changed their intended antibiotic prescription following a negative RADT result. Results: Among the tests performed, 97.7% were easy to interpret. Without RADT, 45 patients were going to be prescribed an antibiotic. After the test result, 27 antibiotic prescriptions were avoided. Tonsil hypertrophy, palatal petechiae, and fever increased the odds of a positive RADT result. Cough was associated with a negative RADT result. Conclusions: This study showed that RADT is easy to implement and contributed to appropriate antibiotic prescription. Tonsil hypertrophy, palatal petechiae, and fever were significantly associated with a positive RADT result, and cough was associated with a negative RADT result. Primary care centers would benefit from having RADT available when there is strong suspicion or doubt of bacterial pharyngitis.

Background: Ovar was the first Portuguese municipality to declare active community transmission of SARS-CoV-2, with total lockdown decreed on March 17, 2020. This context provided conditions for a large-scale testing strategy, allowing a referral system considering other symptoms besides the ones that were part of the case definition (fever, cough, and dyspnea). This study aims to identify other symptoms associated with COVID-19 since it may clarify the pre-test probability of the occurrence of the disease. Methods: This case-control study uses primary care registers between March 29 and May 10, 2020 in Ovar municipality. Pre-test clinical and exposure-risk characteristics, reported by physicians, were collected through a form, and linked with their laboratory result. Results: The study population included a total of 919 patients, of whom 226 (24.6%) were COVID-19 cases and 693 were negative for SARS-CoV-2. Only 27.1% of the patients reporting contact with a confirmed or suspected case tested positive. In the multivariate analysis, statistical significance was obtained for headaches (OR 0.558), odynophagia (OR 0.273), anosmia (OR 2.360), and other symptoms (OR 2.157). The interaction of anosmia and odynophagia appeared as possibly relevant with a borderline statistically significant OR of 3.375. Conclusion: COVID-19 has a wide range of symptoms. Of the myriad described, the present study highlights anosmia itself and calls for additional studies on the interaction between anosmia and odynophagia. Headaches and odynophagia by themselves are not associated with an increased risk for the disease. These findings may help clinicians in deciding when to test, especially when other diseases with similar symptoms are more prevalent, namely in winter.

ABSTRACTGenomic surveillance of SARS-CoV-2 was rapidly implemented in Portugal by the National Institute of Health in collaboration with a nationwide consortium of >50 hospitals/laboratories. Here, we track the geotemporal spread of a SARS-CoV-2 variant with a mutation (D839Y) in a potential host-interacting region involving the Spike fusion peptide, which is a target motif of anti-viral drugs that plays a key role in SARS-CoV-2 infectivity. The Spike Y839 variant was most likely imported from Italy in mid-late February and massively disseminated in Portugal during the early epidemic, becoming prevalent in the Northern and Central regions of Portugal where it represented 22% and 59% of the sampled genomes, respectively, by 30 April. Based on our high sequencing sampling during the early epidemics [15.5% (1275/8251) and 6.0% (1500/24987) of all confirmed cases until the end of March and April, respectively], we estimate that, between 14 March and 9 April (covering the epidemic exponential phase) the relative frequency of the Spike Y839 variant increased at a rate of 12.1% (6.1%–18.2%, CI 95%) every three days, being potentially associated with 24.8% (20.8–29.7%, CI 95%; 3177–4542 cases, CI 95%) of all COVID-19 cases in Portugal during this period. Our data supports population/epidemiological (founder) effects contributing to the Y839 variant superspread. The potential existence of selective advantage is also discussed, although experimental validation is required. Despite huge differences in genome sampling worldwide, SARS-CoV-2 Spike D839Y has been detected in 13 countries in four continents, supporting the need for close surveillance and functional assays of Spike variants.

Este artigo discute a influência exercida pelos aspectos sociais na saúde da criança, tendocomo referência o conceito ampliado de saúde. A compreensão da determinação social dasaúde visa subsidiar práticas mais efetivas, a partir de uma visão integral dos indivíduos, bemcomo da busca pela efetivação da cidadania, única forma de se garantir saúde.

Waste is one of the materials that can pollute the river. Most waste is disposed of into the river so that it will cause pollution in the river. The problem of river pollution, one of which occurs in the Loji River located in Pekalongan City, which still discharges a lot of batik waste carelessly into rivers and waterways. The research was conducted in Loji River, Pekalongan City. The purpose of this study was to determine the water quality and level of water pollution in the Loji River Pekalongan due to batik industry waste. The determination of location used survey method. The sampling method was purposive sampling based on land use activities and ease of access to water collection, which was divided into three segments, namely segment I, segment II, segment III. In each segment, two sample points were taken. Water quality was determined based on Government Regulation Number 22 of 2021 according to river water quality standards. The level of water pollution was determined by the Pollution Index (IP) method. The results showed that based on the parameters that had been tested, the water quality of the Loji River no longer met the class II water quality standards. The level of water pollution in Loji River was categorized as lightly polluted based on the pollution index. The lowest Loji River water pollution index value was 0.731 which was in the good category and the highest value was 1.725 which was in the lightly polluted category.

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Hydrogen has emerged as a promising alternative to meet the growing demand for sustainable and renewable energy sources. Underground hydrogen storage (UHS) in depleted gas reservoirs holds significant potential for large-scale energy storage and the seamless integration of intermittent renewable energy sources, due to its capacity to address challenges associated with the intermittent nature of renewable energy sources, ensuring a steady and reliable energy supply. Leveraging the existing infrastructure and well-characterized geological formations, depleted gas reservoirs offer an attractive option for large-scale hydrogen storage implementation. However, significant knowledge gaps regarding storage performance hinder the commercialization of UHS operation. Hydrogen deliverability, hydrogen trapping, and the equation of state are key areas with limited understanding. This literature review critically analyzes and synthesizes existing research on hydrogen storage performance during underground storage in depleted gas reservoirs; it then provides a high-level risk assessment and an overview of the techno-economics of UHS. The significance of this review lies in its consolidation of current knowledge, highlighting unresolved issues and proposing areas for future research. Addressing these gaps will advance hydrogen-based energy systems and support the transition to a sustainable energy landscape. Facilitating efficient and safe deployment of UHS in depleted gas reservoirs will assist in unlocking hydrogen’s full potential as a clean and renewable energy carrier. In addition, this review aids policymakers and the scientific community in making informed decisions regarding hydrogen storage technologies.

AbstractIn the field of modern education, the meteoric rise in distance learning in higher education has brought unprecedented convenience and accessibility. Yet, beneath the surface of this educational revolution lies the issues of academic stress and burnout among students, particularly distance education students. Therefore, this study examined academic stress and burnout among distance education students at the University of Education, Winneba, Cape Coast Study Center. A quantitative approach was adopted in this study, employing a descriptive cross-sectional survey design. In total, 231 students were selected for this study. The Academic Stress Inventory and Academic Burnout Inventory were adapted as the data collection instruments for this study. Descriptive statistics (frequencies and percentages) and inferential statistics (Two-way MANOVA) were used to analyse the data. This study revealed that distance education students had moderate levels of academic stress and burnout. Additionally, there were no significant gender differences in academic stress and burnout. Conversely, the study discovered significant differences in academic stress, personal burnout, and studies-related burnout based on programme of study. In addition, it was revealed that the interaction effect of gender and programme of study had no significant influence on distance education students’ academic stress and burnout. Consequently, it was recommended that educational institutions should consider creating support programmes tailored specifically for distance education students. These programmes can offer guidance on stress management techniques, time management skills, and resources to help students cope with the demands of their programme.

Abstract Background Human T-cell lymphotropic virus type 1 (HTLV-1), also denominated Human T-cell leukemia virus-1, induces immune activation and secretion of proinflammatory cytokines, especially in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Regulatory T lymphocytes (Tregs) may control of inflammation through the production of regulatory cytokines, including IL10 and TGF-β. In this study we determined the frequencies of CD4 + and CD8 + Tregs in a HAM/TSP population, compared to asymptomatic carriers and uninfected individuals, as well as investigated the profiles of regulatory and inflammatory cytokines. Methods Asymptomatic HTLV-1 carriers and HAM/TSP patients were matched by sex and age. The frequencies of IL10- and/or TGF-β-producing Tregs were quantified by flow cytometry. Real-time reverse transcription polymerase chain reaction (RT-PCR) was used to quantify HTLV-1 proviral load and the mRNA expression of cytokines and cellular receptors in peripheral blood mononuclear cells. Results Total frequencies of CD4 + Tregs, as well as the IL10-producing CD4 + and CD8 + Treg subsets, were statistically higher in patients with HAM/TSP compared to asymptomatic HTLV-1-infected individuals. In addition, a positive correlation was found between the frequency of CD4 + IL10 + Tregs and proviral load in the HAM/TSP patients evaluated. A positive correlation was also observed between gene expression of proinflammatory versus regulatory cytokines only in HAM / TSP group. Conclusions A higher frequencies of IL10-producing Tregs were identified in patients with HAM/TSP. Imbalanced production of IL10 in relation to TGF-β may contribute to the increased inflammatory response characteristically seen in HAM/TSP patients.

Este artigo aborda a questão dos indiscerníveis no contexto do pensamento de Arthur Danto, explorando o desafio de interpretar obras de arte feitas a partir de objetos comuns no mundo cotidiano. No livro A transfiguração do lugar-comum, surgem duas questões fundamentais que promovem a discussão sobre os limites da arte: a relação intrínseca entre aparência e realidade e a indiscernibilidade que se estabelece entre a arte e o objeto comum. Nosso objetivo é compreender como o conceito de representação e interpretação desempenha um papel fundamental na última definição de obra de arte do filósofo, isto é, arte como sonho acordado (Wakeful Dreams).

The School Health Unit (UKS) program has been implemented since 1984. Although this program has been done yearly, the children's health status has not been optimized yet. Studies have been done to evaluate this program, however very limited studies have been done to explore the stakeholders of the program, their roles, and their conflicts, especially at the school level. This study aimed to stakeholder analysis of school health programs at school level. This was a qualitative case study of 4 elementary schools in North Jakarta. Data collection was carried out by means of in-depth interviews. Stakeholder analysis was performed by using steps which consist of identifying stakeholders, identifying interests, analyzing the influence of identified stakeholders and identifying risks, and anticipating risk management. Stakeholder mapping is done using the Grid mapping model. This study shows that in private primary schools, the most influential actors were foundations, namely as “context setters”. In public elementary schools, UKS teachers were the “subjects” and the education authorities were the powerful party in the development of infrastructure. This study also found that there was a conflict between the interests and influence of the main stakeholders, namely foundations and Education Authorities. Foundations and Education Authorities were not directly involved in implementing UKS in schools. This research concludes that the actors have not been maximal in carrying out their roles in the UKS policy at elementary schools in North Jakarta. Cooperation between actors needs to be improved.

Objectives To analyse the differences between nurses with and without substance use disorders (SUDs) admitted to a specialised mental health programme.Design Retrospective, observational study.Setting Specialised mental health treatment programme for nurses in Catalonia, Spain.Participants 1091 nurses admitted to the programme from 2000 to 2021.Interventions None.Primary and secondary outcomes Sociodemographic, occupational and clinical variables were analysed. Diagnoses followed Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision criteria.Results Most nurses admitted to the programme were women (88%, n=960) and came voluntarily (92.1%, n=1005). The mean age at admission was 45 (SD=10.4) years. The most common diagnoses were adjustment disorders (36.6%, n=399), unipolar mood disorders (25.8%, n=282), anxiety disorders (16.4%, n=179) and SUDs (13.8%, n=151). Only 19.2% (n=209) of the sample were hospitalised during their first treatment episode. After multivariate analysis, suffering from a SUD was significantly associated with being a man (OR=4.12; 95% CI 2.49 to 6.82), coming after a directed referral (OR=4.55; 95% CI 2.5 to 7.69), being on sick leave at admission (OR=2.21; 95% CI 1.42 to 3.45) and needing hospitalisation at the beginning of their treatment (OR=12.5; 95% CI 8.3 to 20).Conclusions Nurses with SUDs have greater resistance to voluntarily asking for help from specialised mental health treatment programmes and have greater clinical severity compared with those without addictions. SUDs are also more frequent among men. More actions are needed to help prevent and promote earlier help-seeking behaviours among nurses with this type of mental disorder.

Before making investment decisions, the investor must find out the risk-return characteristics of investments with the help of investment strategies. These investment strategies, including drawdown, tactical asset allocation and short selling, are used by investors and fund managers to improve portfolio performance by maximizing returns and minimizing risks. This study aims to examine the moderating effect of tactical asset allocation on the risk-return relationship in the Nigerian stock market. The study sample is 90 stocks that are consistently traded in the Nigerian stock market within the period of sixteen years on a monthly basis. The study employed time series data which were extracted from the NGX website, annual financial statement, and CBN statistical bulletin. This study's data collection and analysis framework was based on the methodology of Fama and French (2015) using FamaMacbeth's two-step regression. The study used the difference between the logarithmic present value of the price and the previous value of the price to compute the return. Evidence from the result revealed that tactical asset allocation is not significantly priced under the CoFF5F and HMFF5F in the Nigerian stock market. Also, introducing tactical asset allocation as the moderating variable does not improve the relationship between risk and return in the Nigerian stock market. In light of this, the study concluded that tactical asset allocation could not be used to improve the relationship between risk and return through the minimization of risk and maximization of return in the Nigerian stock market. The study recommends that other investment strategies, such as drawdown, short selling etc., can be used by investors to improve the relationship between risk and return in the Nigerian stock market.

Objectives As part of the ‘Suicidality: Treatment Occurring in Paediatrics (STOP)’ study, we developed and performed psychometric validation of an electronic-clinical-outcome-assessment (eCOA), which included a patient-reported-outcome (ePRO), an observer-rated-outcome (eObsRO) for parents/carers and a clinician-reported-outcome (eClinRO) that allows identification and monitoring of medication-related suicidality (MRS) in adolescents.Design STOP: Prospective study: A two phase validation study to assess the impact of medication on suicidal ideations.Setting Six participating countries: Netherlands, UK, Germany, France, Spain and Italy that were part of the Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 261411.Participants Cohort 1 consisted of 41 adolescent-completions, 50 parent-completions and 56 clinician-completions. Cohort 2 consisted of 244 adolescent-completions, 198 parent-completions and 240 clinician-completions from across the six countries. The scale was administered only to participants who have screened positive for the STOP-Suicidality Assessment Scale (STOP-SAS).Results A total of 24 items for the development of the STOP-Medication Suicidality Side Effects Scale (STOP-MS3) were identified and three versions (for patients, parents and clinicians) of the STOP-MS3 were developed and validated in two separate study cohorts comprising of adolescents, their parents and clinicians. Cronbach’s α coefficients were above 0.85 for all domains. The inter-rater reliability of the STOP-MS3 was good and significant for the adolescent (ePRO), clinician (eClinRO) (r=0.613), parent (eObsRO) versions of the scale (r=0.394) and parent and clinician (r=0.347). Exploratory factor analysis identified a 3-factor model across 24 items for the adolescent and parent version of the scale: (1) Emotional Dysregulation, (2) Somatic Dysregulation and (3) Behavioural Dysregulation. For the clinician version, a 4-factor model defined the scale structure: (1) Somatic Dysregulation, (2) Emotional Dysregulation, (3) Behavioural Dysregulation and (4) Mood Dysregulation.Conclusion These findings suggest that the STOP-MS3 scale, a web-based eCOA, allows identification and monitoring of MRS in the adolescent population and shows good reliability and validity.

Background: Breast cancer (BC) screening with mammography reduces mortality but considers currently only age as a risk factor. Personalized risk-based screening has been proposed as a more efficient alternative. For that, risk prediction tools are necessary. Genome-wide association studies have identified numerous genetic variants (single-nucleotide polymorphisms [SNPs]) associated with BC. The effects of SNPs are combined into a polygenic risk score (PRS) as a risk prediction tool. Objectives: We aimed to develop a clinical-grade PRS test suitable for BC risk-stratified screening with clinical recommendations and implementation in clinical practice. Design and methods: In the first phase of our study, we gathered previously published PRS models for predicting BC risk from the literature and validated them using the Estonian Biobank and UK Biobank data sets. We selected the best performing model based on prevalent data and independently validated it in both incident data sets. We then conducted absolute risk simulations, developed risk-based recommendations, and implemented the PRS test in clinical practice. In the second phase, we carried out a retrospective analysis of the PRS test’s performance results in clinical practice. Results: The best performing PRS included 2803 SNPs. The C-index of the Cox regression model associating BC status with PRS was 0.656 (SE = 0.05) with a hazard ratio of 1.66. The PRS can stratify individuals with more than a 3-fold risk increase. A total of 2637 BC PRS tests have been performed for women between the ages 30 and 83. Results in clinical use overlap well with expected PRS performance with 5.7% of women with more than 2-fold and 1.4% with more than 3-fold higher risk than the population average. Conclusion: The PRS test separates different BC risk levels and is feasible to implement in clinical practice.

The early childhood curriculum is an integral part of the educational process, and many countries are looking at how to ensure its quality. With the decentralization of educational content in Lithuania, each Early Childhood Education and Care (ECEC) institution develops its own curriculum. In this case, the role of the head teacher at school and the leadership style they adopt become very important. Our study aims to investigate the expression of shared leadership in Lithuanian preschool education institutions and how it relates to the curriculum quality. An online survey was conducted in spring–autumn 2023. The sample was randomly selected from a list of kindergartens (N = 549) operating in Lithuania, and 133 kindergartens were selected. Of these, 79 (59.4%) institutions responded and agreed to participate. The research sample comprised 461 early childhood educators. The analysis of the survey data showed that distributed leadership can explain 61.3% of the quality of the curriculum. This means that if there is a higher degree of distributed leadership in the early childhood education community, the quality of the ECEC curriculum will likely be higher. ECEC leaders should pay attention to the individual scales of distributed leadership, collaboration, and cooperation.

Napjainkban nemzetközi és hazai színtereken is nagy figyelem összpontosul a tanulási és magatartási nehézségekkel küzdő tanulókra. Évről-évre növekvő számuk arra készteti a pedagógusokat, hogy tovább képezzék magukat, új módszereket sajátítsanak el, melyek segítségével a tanulókat érintő problémákat enyhíthetik, vagy teljesen megszüntethetik. Számos kutatás célkeresztjében az átlag tanulók eredményességének hátterében megbújó okok állnak, miközben kevesen kutatják a beilleszkedési, tanulási, magatartási nehézséggel küzdő (továbbiakban BTMN) tanulók eredményességét befolyásoló személyeket és tényezőket. A tanulmányban elemzésre kerül egy fókuszcsoportos és öt félig strukturált fejlesztő pedagógusokkal készített interjú. Jelenlegi feltáró kutatásunkban arra keressük a választ, hogy milyen szerepet töltenek be a fejlesztő pedagógusok és a tanárok az ilyen nehézségekkel küzdő tanulók életében, továbbá, hogy a BTMN tanulók szülei nagyobb mértékben vonódnak-e be az iskolai oktatásuk során, mint a nem BTMN tanulók szülei.

Soft tissue fabrication using digital light processing remains challenging. Here the authors present a molecular cleavage approach to achieve high-performance bioprinting of constructs with tissue-matching mechanical properties and structural complexity.

Introdução: educadores contribuem para promover educação em saúde escolar. Foi criada a hipótese que eles conheceriam aspectos relacionados a doença celíaca. Objetivo: comparar o conhecimento dos educadores sobre a presença de glúten nos alimentos em relação aos demais funcionários. Métodos: estudo transversal com profissionais de escolas municipais de educação básica de São Carlos (SP), agosto/2018 a janeiro/2019. A amostra com 92 participantes foi selecionada por conveniência. Os dados, coletados por questionário. Variáveis: sexo, estado civil, cargo, idade, tempo de trabalho e conhecimento sobre a presença de glúten nos alimentos apresentados. Foram criados grupos I e II de educadores/estagiários e demais funcionários, respectivamente e escores conforme o percentual de respostas corretas sobre o glúten: “nível elevado” (100% a 75%), “nível intermediário” (0,05). O maior percentual de “nível elevado” foi para farinha de trigo e de “nível baixo” farinha de aveia. Conclusão: o conhecimento variou conforme os tipos de alimentos e foi semelhante entre os grupos.

Visual inspections of the first optical rest-frame images from JWST have indicated a surprisingly high fraction of disk galaxies at high redshifts. Here, we alternatively apply self-supervised machine learning to explore the morphological diversity at z ≥ 3. Our proposed data-driven representation scheme of galaxy morphologies, calibrated on mock images from the TNG50 simulation, is shown to be robust to noise and to correlate well with the physical properties of the simulated galaxies, including their 3D structure. We apply the method simultaneously to F200W and F356W galaxy images of a mass-complete sample ( M _* / M _⊙ > 10 ^9 ) at 3 ≤ z ≤ 6 from the first JWST/NIRCam CEERS data release. We find that the simulated and observed galaxies do not exactly populate the same manifold in the representation space from contrastive learning. We also find that half the galaxies classified as disks—either convolutional neural network-based or visually—populate a similar region of the representation space as TNG50 galaxies with low stellar specific angular momentum and nonoblate structure. Although our data-driven study does not allow us to firmly conclude on the true nature of these galaxies, it suggests that the disk fraction at z ≥ 3 remains uncertain and possibly overestimated by traditional supervised classifications. Deeper imaging and spectroscopic follow-ups as well as comparisons with other simulations will help to unambiguously determine the true nature of these galaxies, and establish more robust constraints on the emergence of disks at very high redshift.

Background and objectives: Essential trace elements obtained from our diet are crucial for the initiation and development of host defence by the immune system. Trace elements such as selenium (Se), zinc (Zn) and copper (Cu) are important for immune competence, particularly in vulnerable population. Poor nutrition status including deficiencies of these vital elements is associated with immune abnormalities and increased susceptibility to infectious diseases. Methods: A comparative study involving a cohort of three hundred and twenty-five (325) participants comprising: 166 persons living with HIV (PLWH) (consisting of 100 on HAART and 66 HAART-treatment naive) and one hundred and fifty-nine (159) non-HIV controls were recruited. Waist to hip ratio and dietary habits were assessed to determine respondents’ nutritional status. Serum Zn, Se and Cu concentrations were estimated by neutron activation method. Results: Mean body mass index (BMI) of respondents was 24.7±4.8 kg/m2. Dietary recommended intakes (DRIs) of macronutrient [energy (69%), carbohydrates (86%) and fats (76%)] and micronutrient [(vitamin B2 (63%), vitamin D (15%), folate (47%) and calcium (63%)] were not adequately met by all groups. PLWH on HAART had a significantly higher total body fat (p=0.004) and visceral fat (p

Abstract Background It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war‐torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war‐affected youth and compared the symptom networks of children and adolescents. Methods The overall sample comprised 2007 youth (6–18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict. Youth reported their PTSD symptoms using a self‐report questionnaire in Palestine and structured clinical interviews in all other countries. We computed the networks of the overall sample and of two sub‐samples of 412 children (6–12 years) and 473 adolescents (13–18 years) and compared the structure and global connectivity of symptoms among children and adolescents. Results In both the overall sample and the sub‐samples, re‐experiencing and avoidance symptoms were most strongly connected. The adolescents' network had a higher global connectivity of symptoms than the children's network. Hyperarousal symptoms and intrusions were more strongly connected among adolescents compared to children. Conclusion The findings lend support to a universal concept of PTSD among youth characterized by core deficits in fear processing and emotion regulation. However, different symptoms may be particularly important in different developmental stages, with avoidance and dissociative symptoms dominating in childhood and intrusions and hypervigilance gaining importance in adolescence. Stronger symptom connections may render adolescents more vulnerable to the persistence of symptoms.

No período compreendido entre 18 de fevereiro de 2011 e 29 de maio de 2015 funcionou no bairro do Canela uma unidade do Programa Farmácia Popular como Farmácia Escola (Farmácia da Universidade) com o objetivo de se materializar um campo de prática para os alunos da Faculdade de Farmácia da Universidade Federal da Bahia. O Programa de Farmácia Popular do Brasil dispensou medicamentos essenciais com redução de gastos familiares com medicamentos, uma vez que o Programa subsidia até 90% do custo dos medicamentos. Com a implantação do programa “Saúde não tem Preço” e “Brasil Carinhoso” nas Farmácias Populares do Brasil os medicamentos para hipertensão, diabetes e asma foram disponibilizados gratuitamente, favorecendo ainda mais o acesso. Durante o primeiro ano de funcionamento a Farmácia da Universidade atendeu aproximadamente 30.000 usuários, com um público diversificado: usuários de SUS, usuários de sistema privado de saúde, discentes, docentes e técnicos da Universidade Federal da Bahia, inclusive usuários do Serviço Médico Universitário Rubens Brasil (SMURB). Nos anos seguintes houve crescimento de demanda atendida, ultrapassando até maio de 2015 o volume de atendimentos de 150.000 usuários. A participação ativa de discentes na rotina da Farmácia da Universidade, seja pela prática de estágio curricular, seja em vivências educativas para maior compreensão e criticidade entre teoria e prática dos conteúdos programáticos, propiciou a esses alunos a oportunidade de desenvolver habilidades e competências através do aprender fazendo. Durante o período de funcionamento da unidade, foram beneficiados mais de 300 alunos, sendo 175 presencialmente na unidade ao longo dos anos, assistidos pelos docentes dos componentes curriculares: Gestão e Planejamento de Serviços de Saúde, Introdução: à Atenção Farmacêutica, Introdução: ao Estudo das Ciências Farmacêuticas, Introdução: a Saúde Coletiva, Estágio Modular I e II, Administração de Empresas Farmacêuticas e Estágio Final de Curso, além de práticas sanitárias, tais como: Programa de Gerenciamento de Resíduos em Serviço de Saúde, Dispensação de Medicamentos Controlados – ênfase em RDC 20/2011, Prática de Atenção Farmacêutica – Programa Piloto de Segmento Farmacoterapêutico, entre outros. Na preceptoria dos alunos atuavam os profissionais farmacêuticos efetivos da Universidade Federal da Bahia e da Fundação Bahiafarma e na tutoria, os docentes envolvidos nos componentes curriculares. Em maio de 2015, alegando a necessidade de venda de ativos da Empresa Baiana de Alimentos (EBAL) pelo governo do estado, foram fechadas as 24 farmácias populares que funcionavam na Bahia através de convênios entre a Secretaria de Saúde do Estado (SESAB) e o Ministério da Saúde e entre essas a Farmácia da Universidade, única no país como Farmácia Escola que conciliava a dispensação de medicamentos industrializados através do Programa Farmácia Popular do Brasil e medicamentos manipulados.

AIMS OF THE STUDY: Globally, since the introduction of conjugate-vaccines against encapsulated bacteria, respiratory viruses have caused most hospitalisations for community-acquired pneumonia. The aim of this study was to describe pathogens detected and their association with clinical findings in Switzerland. METHODS: Baseline data were analysed for all trial participants enrolled between September 2018 and September 2020 into the KIDS-STEP Trial, a randomised controlled superiority trial on the effect of betamethasone on clinical stabilisation of children admitted with community-acquired pneumonia. Data included clinical presentation, antibiotic use and results of pathogen detection. In addition to routine sampling, nasopharyngeal specimens were analysed for respiratory pathogens using a panel polymerase chain reaction test covering 18 viral and 4 bacterial pathogens. RESULTS: 138 children with a median age of 3 years were enrolled at the eight trial sites. Fever (obligatory for enrolment) had been present for median 5 days before admission. Most common symptoms were reduced activity (129, 93.5%) and reduced oral intake (108, 78.3%). Oxygen saturation

Sepsis is a medical emergency that describes the body's systemic immunological response to infectious processes that can lead to end-stage organ dysfunction and death. The role of nurses in tackling sepsis patients is critical to identifying the initial condition of sepsis and reducing the continuation of even more severe sepsis. This narrative review aims to identify the role of nurses in treating sepsis patients in critical care units. This research method was the narrative review by analyzing online search databases namely Pubmed, Google Scholar, and Science Direct. The search inclusion criteria were an English-language article, published in 2008-2021, full text, the keywords used were "sepsis", "the role of nurses", "critical care". Our search found 11 articles showed that the role of nurses in treating sepsis patients is early introduction to sepsis to start treatment, team training to ensure a safe and effective approach and the implementation of infection prevention and control measures as prevention of sepsis. So the role of nurses in tackling sepsis patients is critical to identifying the early conditions of sepsis, controlling and preventing sepsis, preventing the progression of the disease and contributing to decreased morbidity and mortality.Keywords: sepsis; the role of nurses; critical care ABSTRAK Sepsis merupakan keadaan darurat medis yang menggambarkan respons imunologi sistemik tubuh terhadap proses infeksi yang dapat menyebabkan disfungsi organ stadium akhir dan kematian. Peran perawat dalam menanggulangi pasien sepsis sangatlah penting untuk mengidentifikasi kondisi awal sepsis serta mengurangi kelanjutan sepsis yang lebih berat lagi. Tinjauan naratif ini bertujuan untuk mengidentifikasi peran perawat dalam merawat pasien sepsis di unit critical care.Metode penelitian ini adalah narrative review dengan menganalisis database online pencarian yaitu Pubmed, Google Scholar, dan Science Direct. Kriteria inklusi pencarian adalah artikel berbahasa inggris, terbit tahun 2008-2021, full text, dengan kata kunci pencarian “sepsis”, “the role of nurses”, “critical care”. Dari hasil penelusuran kami menemukan 11 artikel yang menunjukkan bahwa peran perawat dalam merawat pasien sepsis yaitu adanya pengenalan dini terhadap sepsis untuk memulai pengobatan, pelatihan tim untuk memastikan pendekatan yang aman dan efektif serta penerapan langkah-langkah pencegahan dan pengendalian infeksi sebagai pencegahan sepsis. Sehingga peran perawat dalam menanggulangi pasien sepsis sangatlah penting untuk mengidentifikasi kondisi awal sepsis, pengendalian dan pencegahan sepsis, mencegah perkembangan penyakit dan berkontribusi pada penurunan morbiditas dan mortalitas.Kata kunci: sepsis; peran perawat; perawatan kritis

Background and Objectives: About 40% of early undifferentiated arthritis (UA) progresses to rheumatoid (RA) or other chronic arthritis. Novel diagnostic tools predicting the risk for this progression are needed to identify the patients who would benefit from early aggressive treatment. Evidence on the role of single-nucleotide polymorphisms (SNPs) in the development of RA has emerged. The aim of our study was to investigate the association between rs2476601, rs833070, and rs6920220 SNPs and UA progression to RA. Materials and Methods: Ninety-two UA patients were observed for 12 months. At study entry, demographic and clinical characteristics were recorded, musculoskeletal ultrasonography was performed, and blood samples were drawn to investigate levels of inflammatory markers, rheumatoid factor (RF), anti-citrullinated protein antibodies (anti-CCP)detect SNPs. After 12 months, UA outcomes were assessed, and patients were divided into two (RA and non-RA) groups. The association between the risk of progression to chronic inflammatory arthritis and analyzed SNPs was measured by computing odds ratios (OR). Results: After a 12-month follow-up, 27 (29.3%) patients developed RA, and 65 (70.7%) patients were assigned to the non-RA group. The arthritis of 21 patients (22.8%) from the non-RA group resolved completely, while the other 44 (47.2%) patients were diagnosed with another rheumatic inflammatory disease. The patients who developed RA had a significantly greater number of tender and swollen joints (p = 0.010 and p = 0.021 respectively) and were more frequently RF or anti-CCP (p < 0.001), and both RF and anti-CCP positive (p < 0.001) at the baseline as compared with the patients in the non-RA group. No significant association between rs2476601 (OR = 0.99, p = 0.98), rs833070 (OR = 1.0, p = 0.97), and rs6920220 (OR = 0.48, p = 0.13) polymorphisms and the risk of developing RA were found. Conclusions: No association between analyzed SNPs and a greater risk to progress from UA to RA was confirmed, although patients with rs6920220 AA + AG genotypes had fewer tender joints at the disease onset.

Introdução: A Vitamina K age no organismo promovendo a síntese dos fatores de coagulação podendo ser administrada por via diferentes vias. No Brasil, existem disponíveis apenas apresentações para administração por via parenteral. Objetivo: Descrever o uso por via oral da solução injetável da vitamina K em pacientes hospitalizados. Método: Estudo observacional, retrospectivo realizado em um hospital terciário no período de janeiro 2014 a julho de 2016. Resultados: Dos 54 pacientes, 31 (57%) utilizaram a vitamina K para reverter o efeito da varfarina e 23 (43%) pacientes utilizaram para um motivo diferente. Dez (32%) apresentavam RNI > 10, treze (42%) apresentavam RNI entre 10 e 4,5, cinco (16%) apresentam RNI entre 4,5 e 3. Três (10%) apresentavam RNI entre 2-3 e apenas 1 paciente apresentava RNI inferior a 2. Após a utilização da vitamina K, vinte pacientes (64%) apresentaram RNI subterapêutico. Os 23 (43%) pacientes que utilizaram a vitamina por outro motivo, a faixa de RNI antes da utilização variou entre 7,18 e 1,31, sendo que 10 (43%) apresentavam RNI entre 7,18 e 2 e os 13 (57%) restantes apresentavam RNI inferior a 2. Conclusão: A administração da vitamina K por via oral foi bem tolerada, porém houve divergências com relação à recomendações de doses e indicações encontradas na literatura.

The mechanism of the hydrophobized poly(ethylene glycol) (PEG)/K+ system inhibiting shale hydration was studied by laboratory experiment. The inhibition performance was evaluated through cuttings hot-rolling dispersion, bentonite inhibition and contact angle tests. The inhibition became stronger as contact angle and PEG concentration increased. A modified cuttings hot-rolling dispersion experiment suggested that these molecular systems did not act through the thermally activated mud emulsion (TAME) mechanism. The interaction of the PEG/K+ with clay samples was investigated through adsorption studies and by Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD) and thermogravimetric analysis (TGA). The adsorption isotherms showed that the presence of K+ increased the PEG affinity for the clay surface. This inhibition effect was accompanied by a reduction of the bentonite hydration with PEG adsorption, evidenced by FT-IR, TGA and differential thermogravimetric (DTG) curves. XRD patterns were conclusive in showing that the presence of K+ ions limited the expansion of the clay interlamellar region to only one PEG layer, and the terminal hydrophobic segments of the PEG chains turned out to be determinant in enhancement of the inhibitory efficiency. The cuttings hot-rolling dispersion was carried out on water-base drilling fluid with PEG/K+, which proved the inhibition performance of PEG/K+ in oil field drilling.

Abstract Background Entomopathogenic nematodes (EPNs) of the families Heterorhabditidae and Steinernematidae are used as biological control agents of several insect pests in lieu of synthetic pesticides. Results Using an insect-baiting technique, naturally occurring EPN isolates were collected from banana and rice fields in the municipality of Hagonoy, the Philippines. A total of 4 isolates were recovered from all the sites namely, HBP1, HBP2, HR3 and HR4. By combining morphometrical and ITS rDNA data, all the isolates were identified as Heterorhabditis indica. To initially assess their infectivity, virulence tests were conducted on the last instar larvae of the super worm, Zophobas morio Fabricius (Coleoptera: Tenebrionidae), the model insect. HR3 isolate had the highest percentage mortality (56%), followed by HBP1 and HBP2 (33%), which were comparable to the available nematode in the market, Heterorhabditis bacteriophora (44%), whereas the lowest was obtained in HR4 isolate (11%). Conclusions This study accounted 4 more H. indica isolates in addition to pre-existing isolates in the country, expanding its habitat range and geographic distribution. This also provides baseline information on the potential biocontrol utilization of native EPNs against soil-dwelling insect pests of agricultural crops. Further investigations are required to assess their efficacy against several other insect pests of economic importance for the integrated pest management (IPM) programmes in the country.

Breast cancer risk for BRCA1/BRCA2 mutation carriers varies depending on other genetic factors. Here, the authors perform a case-only genome-wide association study and highlight novel loci associated with breast cancer risk for BRCA1/BRCA2 mutation carriers.

TRAINING OF ANTY-HYPERTENSION CADRES IN RW 15, PENJARINGAN, NORTH JAKARTA. The prevalence of NCD Non-Communicable Diseases (NCD) in Indonesia is increasing, including hypertension. DKI Jakarta is one of the provinces with high prevalence of hypertension. To prevent complications due hypertension, regular screening and monitoring of risk factors is needed. Screening and monitoring of risk factors have been carried out by health officers through Posbindu PTM, also the active role of the community is needed. RW 15 Penjaringan is one of the RW with high prevalence of hypertension (29.9%) even though they already have Posbindu. The problems that occur in their Posbindu are the low number of visits by people with hypertension, the cadres lacks of knowledge about hypertension, lack of skills in measuring blood pressure, and lack of tensimeter to cover people with hypertension. To overcome this problem, RW 15 runs an anti-hypertension program that requires active and skilled cadres. It is necessary to train cadres for the sustainability of the program. These cadre training includes a pre-post test to measure cadres' knowledge, provide education about hypertension, then demonstrations and simulations of blood pressure measurement. After that, the cadres' knowledge of hypertension increased, and all cadres were able to measure blood pressure using a tensimeter. It is hoped that when the program run, cadres will be able to apply what was done during the training properly, and material refreshment should be done to maintain the quality of cadres’ knowledge.

This article examined the honey-bearing potential of Tilia cordata Mill. stands in the Southern Urals using forest management and taxation methods. The studies were conducted in pure and mixed even- and uneven-aged forests with T. cordata Mill. in different natural zones of the Southern Urals on the territory of the Bashkirs. These were forests of the South Ural forest-steppe region, the forest-steppe region of the European part of Russia, the area of coniferous-deciduous (mixed) forests of the European part of Russia. The research employed the method of laying temporary and permanent trial areas. T. cordata Mill. forests on the republic’s territory were divided into zones by forest districts. There is a discrepancy between the territorial localization of “nectar” (honey-bearing) linden and designated forest areas, that is, honey-bearing forest areas on the republic’s territory. It could be due to the lacking methodology for assigning linden to these categories. The increased rotation age of linden trees to 81–90 years for several decades, a ban on final cutting, reduced annual cut of soft-leaved forests by 15% enlarged the stocks of overmature forest to 48%. Depending on the age, the number of flowers on one T. cordata Mill. tree varies from 0 to 60.2 thousand pieces. The maximum amount of nectar is 69.04 kg/ha at 12-day linden flowering. The honey productivity of plants including T. cordata Mill., calculated concerning the linden age, its share in the forest composition, the average number of flowers on the tree, nectar per 1 ha of linden and the flowering period ranged from 252.8 to 662.8 kg/ha.

Objectives: While receptive art engagement is known to promote health and wellbeing, active art engagement has not been fully explored in health and nursing care. This review is to describe the existing knowledge on art making and expressive art therapy in adult health and nursing care between 2010 and 2020. Methods: Relevant studies and grey literature were searched and identified between March 17 and April 10, 2020 from EBSCO, CINAHL, Medline and ERIC databases and a general Internet search. Following data charting and extraction, the data (n = 42 papers) were summarized and reported in accordance with PRISMA-ScR guidelines. Results: In the included papers, both art making and expressive art therapy were seen in different health care and nursing contexts: yet not the home care context. The emphasis of art activities were group activities for chronically or terminally ill residents, adults aged 65 years or older. A focus on personal narrative was often seen, which may explain why art activities appear to be linked to acknowledging and building new strengths and skills, making meaning of experiences, personal growth, symptom alleviation, and communication; all used to foster collaboration between patients, patients’ near-ones and health care professionals. Conclusions: Art activities appear to be suitable for every context and can promote personcenteredness and the measurement of nursing outcomes, and they should be considered an essential part of health and nursing care, nursing education and care for health care personnel.

Este estudo analisou as abordagens de estudo, percepções do ambiente acadêmico, motivação e preferências de aprendizagem dos acadêmicos em uma instituição de ensino superior localizada na região oeste do Estado do Paraná. Quanto ao método, utilizou-se de uma pesquisa de levantamento, abordagem quantitativa e natureza descritiva, as fontes de dados se deu por meio de questionário, apresentado por Ullah, Richardson & Hafeez (2011). No processo de análise utilizou-se de estatísticas descritivas, análise de confiabilidade, análise fatorial, testes de normalidade, análises de correlações, análise de agrupamentos e testes de comparativos de médias. Quanto aos resultados, verificou-se que a qualidade percebida possui um relacionamento mais forte com a abordagem profunda de estudo, preferência dos acadêmicos por cursos que tenham características de suporte de entendimento e, ainda, as variáveis habilidades, qualidade do ensino docente e recursos físicos, que fazem parte da avaliação o ambiente acadêmico, relacionam positivamente com a qualidade percebida.

Activated rheumatoid arthritis (RA) synovial fibroblasts (SFs) are among the most important cells promoting RA pathogenesis. They are considered active contributors to the initiation, progression, and perpetuation of the disease; therefore, early detection of RASF activation could advance contemporary diagnosis and adequate treatment of undifferentiated early inflammatory arthritis (EA). In this study, we investigated the expression of nucleotide-binding, oligomerization domain (NOD)-like receptor family, pyrin domain containing (NLRP)1, NLRP3 inflammasomes, Toll-like receptor (TLR)1, TLR2, TLR4, vitamin D receptor (VDR), and secretion of matrix metalloproteinases (MMPs) in SFs isolated from patients with RA, osteoarthritis (OA), EA, and control individuals (CN) after knee surgical intervention. C-reactive protein, general blood test, anticyclic citrullinated peptide (anti-CCP), rheumatoid factor (RF), and vitamin D (vitD) in patients’ sera were performed. Cells were stimulated or not with 100 ng/ml tumor necrosis factor alpha (TNF-α) or/and 1 nM or/and 0.01 nM vitamin D3 for 72 h. The expression levels of NLRP1, NLRP3, TLR1, TLR2, TLR4, and VDR in all examined SFs were analyzed by quantitative real-time PCR (RT-qPCR). Additionally, the secretion of IL-1β by SFs and MMPs were determined by ELISA and Luminex technology. The expression of NLRP3 was correlated with the levels of CRP, RF, and anti-CCP, suggesting its implication in SF inflammatory activation. In the TNF-α-stimulated SFs, a significantly lower expression of NLRP3 and TLR4 was observed in the RA group, compared with the other tested forms of arthritis. Moreover, upregulation of NLRP3 expression by TNF-α alone or in combination with vitD3 was observed, further indicating involvement of NLRP3 in the inflammatory responses of SFs. Secretion of IL-1β was not detected in any sample, while TNF-α upregulated the levels of secreted MMP-1, MMP-7, MMP-8, MMP-12, and MMP-13 in all patient groups. Attenuating effects of vitD on the expression of NLRP3, TLR1, and TLR4 suggest potential protective effects of vitD on the inflammatory responses in SFs. However, longer studies may be needed to confirm or fully rule out the potential implication of vitD in SF activation in inflammatory arthritis. Both VDR and NLRP3 in the TNF-α-stimulated SFs negatively correlated with the age of patients, suggesting potential age-related changes in the local inflammatory responses.