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Abstract Objective There is a rising effort for hospital emergency departments (EDs) to offer and expand substance use disorder (SUD) services. This state-wide evaluation studies SUD services offered along the continuum of implementation across Kentucky’s EDs to inform future state efforts to build ED bridge programs. Methods We conducted a mixed-methods study using an online survey of all Kentucky Emergency Department Directors between January and May of 2023. We created a hospital-level dataset which we used to summarize quantitative questions and thematically analyze open-ended responses. Results Our sample included 85 unique respondents (89% of all eligible Kentucky hospitals). Nine (11%) had active bridge programs to initiate opioid use disorder patients on buprenorphine. Respondents reported that the most challenging SUD-related services for EDs to implement were buprenorphine induction for opioid use disorder treatment (n = 36, 42%), referrals to community-based providers (n = 34, 40%), and providing social work services (n = 25, 29%). Respondents noted that the implementation and improvement of screening protocols were needed to better identify patients with SUD, expressed concerns about care continuity, and explicitly conveyed the need and desire for additional supports to provide SUD care. Conclusions The landscape of Kentucky’s ED SUD supports shows several hospitals that offer services along the continuum of SUD care, and highlights the importance of technical assistance and financial resources to ensure the continuum is broadly available. Kentucky’s experience speaks to broader national challenges in supporting SUD in EDs – specifically the need for financial resources, buy-in and education, and creating referral relationships to ensure care continuity.

Abstract Background Aging leads to a decline in muscle mass and strength, contributing to frailty and decreased quality of life. Sirolimus (rapamycin) , an mTOR inhibitor, has shown potential in preclinical studies to extend lifespan and improve health span. This study evaluates the safety and efficacy of once-weekly sirolimus (rapamycin) administration on muscle strength and endurance in older adults engaged in a 13-week exercise program. Methods This randomized, double-blind, placebo-controlled trial will enroll 40 participants aged 65–85. Participants will be randomly assigned to receive either sirolimus (rapamycin) 6 mg/week or placebo for 13 weeks, in conjunction with an at-home exercise program. The primary outcome measure is the change in muscle strength and endurance, assessed by the 30-Second Chair-Stand Test. Secondary outcome measures include adverse events, changes in muscle strength and endurance as measured by the 6-min walk test, handgrip strength, and participant-reported outcomes using the SF-36 survey. Assessments will be conducted at baseline, mid-intervention (week 6), and post-intervention (week 13). Blood samples will be collected for hematology and biochemistry analyses, including full blood count, urea and electrolytes, liver function tests, HbA1c, lipids, serum IGF-1, and hs-CRP. DNA methylation will be analyzed using TruDiagnostic™ to explore changes in biological age. Discussion This study aims to provide insights into the potential benefits of intermittent sirolimus (rapamycin) administration on muscle performance in older adults. By alternating periods of mTOR inhibition through rapamycin and activation via exercise, this study will explore a novel approach to enhancing muscle strength and endurance in the aging population. The results could have significant implications for developing interventions to improve physical function and overall health outcomes in older adults. Safety and tolerability will also be closely monitored to ensure the feasibility of this regimen for wider application. Trial registration Australia New Zealand Clinical Trials Registry, ACTRN12624000790549. Registered on 26 June 2024 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12624000790549 .

El propósito de este texto es reflexionar sobre el libro El Nombre de la Rosa. Esta poesía intelectual nos permite analizar la evolución de la percepción de los Universales a lo largo de la historia. Desde el título hasta su final, el autor nos lleva en un camino lleno de cambios históricos y autopercibidos. Es interesante cómo el contexto determinante siempre juega un papel relevante y el poder de las ideas trasciende muchas veces la realidad que uno experimenta. En este sentido, Umberto Eco, nos muestra como diferentes aspectos filosóficos pueden implementarse sin tener que elegir uno por sobre otro, lo que nos lleva a meditar sobre la utopía en la simbiosis filosófica. Este enfoque permite ver la relación entre los aspectos ontológicos, gnoseológico, lingüísticos y otros campos, como la medicina. En los siguientes párrafos, exploraré algunos de estos aspectos y cómo se entrelazan con nuestra disciplina. La filosofía nos permite analizar y comprender los conceptos abstractos que subyacen a la práctica médica; y puede ayudarnos a mejorar la calidad de atención que brindamos a nuestros pacientes, como a nuestra relación con colegas.

Background: Body balance is regulated by sensory information from the vestibular, visual and somatosensory systems, and changes in one or more of these sensory systems can trigger balance disorders. Individuals with type 2 Diabetes Mellitus (DM2) often present peripheral neuropathy, a condition that alters foot sensory information and can negatively influence balance and gait performance of these subjects. Objective: To evaluate and compare balance, gait, functionality and the occurrence of falls between individuals with and without a clinical diagnosis of DM2 with associated peripheral neuropathy. Methods: Cross-sectional study, which evaluated seventy individuals, thirty-five with and thirty-five without a clinical diagnosis of DM2, of both sexes and age range between 50 and 85 years, who were recruited from Basic Health Units of Serra Talhada, Pernambuco state, Brazil. The volunteers’ balance was analyzed using the Berg Balance Scale, gait-related functional tasks were measured using the Dynamic Gait Index, functional mobility was assessed using the Timed Up and Go test and functionality was assessed using the Katz Index. The occurrence of falls was recorded by the volunteers’ self-report. Results: Individuals with DM2 demonstrated the worst performance in balance (p = 0.000) and in gait-related functional tasks (p = 0.000), slower functional mobility (p = 0.000) and worse functionality (p = 0.016) compared to the group without DM2, demonstrating significant differences for all analyzed outcomes. A greater occurrence of falls was observed in individuals with DM2, compared to those without the disease (p = 0.019). Conclusion: Individuals with DM2 demonstrated worse performance on balance, gait-related functional tasks, slower functional mobility and worse functionality compared to those without the disease. Individuals with DM2 had the highest occurrence of falls in this study.

Abstract Background The new P-STEP® (Personalised Space Technology Exercise Platform) app is designed to bring together tailored exercise guidance and up-to-date air quality information. The app allows individuals to plan outdoor exercise walking routes while minimising their exposure to air pollution. Individuals with chronic long-term conditions, particularly respiratory and cardiovascular conditions, can use the app in order to minimise the risk of their symptoms being exacerbated by pollution, while still gaining the benefits of outdoor exercise. Methods This study will measure the usability and acceptability of the P-STEP® app. The study will take the form of a single-arm 12-week app pilot study based in Leicestershire, United Kingdom (UK). We will recruit a maximum of 380 participants from an existing cohort study to pilot the app for 12 weeks. Questionnaire data will be collected at three timepoints, baseline, 6 weeks and 12 weeks. The primary outcome is the System Usability Scale at 12 weeks. Secondary outcomes include the User Engagement Scale Short Form, SF-12, Recent Physical Activity Questionnaire (RPAQ), bespoke, app specific usability questions, and feasibility outcomes. Additional data collected includes participant demographic information, technology self-efficacy and adverse events. Weekly anonymised usage data from the app will also be collected by the app team and analysed separately to complement the questionnaire data. Discussion This study will help us better understand the feasibility and acceptability of using the P-STEP® in the community. The results will also help inform future studies. Ethics and dissemination This study has received ethical approval from the South West Frenchay Research Ethics (23/SW/0060) Committee. There is no need for further approval from the Health Research Authority as the study is not taking place in the NHS. The ClinicalTrials.gov ID number is NCT05830318.

Sexual self-disclosure (SSD) is when a person shares information about their sexuality with another person. Technology-mediated communication is pervasive in modern society, yet researchers have not distinguished between SSDs that occur in-person versus in technology-mediated contexts. Using the Interpersonal Exchange Model of Sexual Satisfaction, researchers previously found that SSD predicts sexual rewards, costs, and satisfaction. In this study, we (1) compared cisgender/transgender men’s and women’s frequency (how much) and breadth (how many topics) of SSD via typed technology and in-person (H1, H2), and (2) examined the extent to which the frequency and breadth of SSD in each context predicted perceived sexual rewards, comparison of sexual rewards, and in turn sexual satisfaction while controlling for relationship satisfaction (H3, H4, H5, H6). Undergraduate students (N = 450) completed an online survey that assessed SSD in each context, perceived sexual rewards and costs, comparison of own and partner’s sexual rewards and costs, and sexual and relationship satisfaction. Participants reported more frequent and greater breadth of SSD in-person than via technology. We also found that women disclosed more sexual topics than men in-person but not through typed technology. Using path analyses, a greater frequency of SSD in-person predicted greater perceived sexual rewards and comparison sexual rewards, and in turn, greater sexual satisfaction. The frequency of SSD via typed technology and the SSD breadth in either context did not predict exchanges or sexual satisfaction.

Abstract In humans, blood Classical CD14+ monocytes contribute to host defense by secreting large amounts of pro-inflammatory cytokines. Their aberrant activity causes hyper-inflammation and life-threatening cytokine storms, while dysfunctional monocytes are associated with ‘immunoparalysis’, a state of immune hypo responsiveness and reduced pro-inflammatory gene expression, predisposing individuals to opportunistic infections. Understanding how monocyte functions are regulated is critical to prevent these harmful outcomes. We reveal platelets’ vital role in the pro-inflammatory cytokine responses of human monocytes. Naturally low platelet counts in patients with immune thrombocytopenia or removal of platelets from healthy monocytes result in monocyte immunoparalysis, marked by impaired cytokine response to immune challenge and weakened host defense transcriptional programs. Remarkably, supplementing monocytes with fresh platelets reverses these conditions. We discovered that platelets serve as reservoirs of key cytokine transcription regulators, such as NF-κB and MAPK p38, and pinpointed the enrichment of platelet NF-κB2 in human monocytes by proteomics. Platelets proportionally restore impaired cytokine production in human monocytes lacking MAPK p38α, NF-κB p65, and NF-κB2. We uncovered a vesicle-mediated platelet-monocyte-propagation of inflammatory transcription regulators, positioning platelets as central checkpoints in monocyte inflammation.

Abstract Background Canada’s immigrants and refugees have often settled in large Canadian cities, but this is changing with rising costs of living and rural settlement initiatives. However, little consideration is made regarding systemic changes needed to accommodate this distribution, particularly in healthcare in medium-sized cities or smaller communities. For most Canadians, primary care is an entry point into the healthcare system but immigrants and refugees face unique barriers to accessing care compared to the general Canadian population. This project aimed to better understand the barriers to accessing primary care among newcomers in Peterborough, Ontario from the perspective of newcomer service providers. Methodology Participants were recruited from community organizations identified by the local settlement agency, the New Canadians Centre, as having regular interactions with newcomer clients including clinics, not-for-profit organizations, and volunteer groups. Four focus groups were completed, each with three participants (n=12). A coding grid was deductively developed to guide thematic analysis by adapting Levesque et al.’s conceptual framework defining access to healthcare with five specific dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness. Results Participants identified lack of awareness of the healthcare system, stigma, competing priorities, and direct costs as some of the barriers for newcomers. Participants highlighted barriers unique to Peterborough including proximity to services, social isolation, and a shortage of family physicians. The results also highlighted strengths in the community such as its maternal-child health programming. Conclusion The results provide a glimpse of the challenges to accessing primary care among newcomers in medium-sized communities and identify opportunities to prepare for changing settlement patterns.

Abstract Background With one in five individuals aged 65 or older living with type 2 diabetes worldwide, it is crucial to acknowledge and address the challenges faced by this population. In this context, our study aims to evaluate the efficacy of a behavioral intervention model delivered through a smart speaker on mental health and diabetes self-care in the elderly with diabetes. Methods This is a single-center, pragmatic, parallel two-arm open randomized clinical trial involving elderly patients with type 2 diabetes. We plan to enroll a total of 112 individuals who will be randomized 1:1 to receive the Smart Speaker EchoDot 3rd Gen device (Amazon Echo®) for home use (intervention arm) or to maintain usual care (control arm). The primary outcome is mental distress, assessed using the 20-item Self Reporting Questionnaire (SRQ-20) after a 12-week intervention period. Secondary outcomes include quality of life, adherence to diabetes self-care behaviors, perception of stress, glycemic control, blood pressure, and lipid profile. Analysis of covariance (ANCOVA) will be used to evaluate the effects of the intervention on the outcomes. Discussion This study assesses the effectiveness of an interactive virtual assistance system for enhancing mental health and glycemic control among elderly individuals with type 2 diabetes. The findings may introduce smart speakers as a valuable tool for promoting diabetes-related self-care in this population. Trial registration ClinicalTrials.gov NCT05329376. Registered on 15 April 2022. Enrollment began on 20 June 2023 and the last update of protocol was on 13 December 2023.

RESUMO Introdução: Os métodos ativos de aprendizagem têm adquirido crescente relevância, promovendo aprimoramento das relações interpessoais e maior aproximação com a prática profissional. Este artigo tem como objetivo relatar a experiência de um grupo de estudantes dos cursos de Medicina e Enfermagem, ao empregarem o método ativo de aprendizagem da problematização para exploração da Política Nacional de Atenção Integral à Saúde da Criança (Pnaisc). Relato de experiência: A vivência envolveu 13 estudantes de Medicina e Enfermagem que, após vivências no Sistema Único de Saúde e tendo como propósito a apreensão das políticas públicas de saúde, sentiram-se motivados à elaboração de trabalho sobre a Pnaisc. O processo contemplou aprofundamento na política, por meio de artigos e manuais, seguido pela estruturação e produção do trabalho em formato de vídeo no estilo Draw my Life, incorporando ilustrações e narração simultânea. O vídeo foi exibido em plenária com todos os estudantes da série e compartilhado no YouTube, obtendo expressivo número de visualizações e comentários positivos. Discussão: A construção ativa e aprofundada do vídeo proporcionou aos estudantes compreensão significativa acerca da Pnaisc, política centrada na criança que visa articular ações e serviços de saúde nas Redes de Atenção à Saúde. Além de contribuir para compreensão desse tema crucial na formação de profissionais de saúde, o projeto estimulou o desenvolvimento de competências adicionais, incluindo busca ativa e análise crítica de dados. Conclusão: O método ativo adotado foi amplamente valorizado pelos membros do grupo de trabalho e pelos participantes da plenária como ferramenta eficaz para despertar o interesse dos estudantes no conteúdo abordado, resultando em compreensão facilitada.

Introduction Early exposure to medical school offices can help to facilitate interest in academic medicine and senior leadership positions. This workshop provides an overview of the roles, responsibilities, and activities within the Office of Faculty Affairs (OFA) and highlights opportunities for trainee engagement and leadership. Methods The Kern model was applied in the design of a 60-minute interactive module for medical students. The module consisted of a didactic portion overviewing OFA roles and responsibilities. Learners were engaged through reflection exercises and case discussions on how trainees could develop competencies through engagement with the OFA, including contributing to faculty grievance and promotion processes. A summary sheet was created to explicitly describe faculty leadership competencies potentially developed by medical students through faculty affairs–related activities. Results The module was presented at five conferences, and 45 participants responded to the workshop evaluation forms. A comparison of pre- and postworkshop responses showed a statistically significant increase in perceived knowledge in identifying leadership opportunities for trainees to become engaged through the OFA and in listing skills that are important for an OFA dean. Discussion Medical trainees not only can benefit from gaining awareness of opportunities for engagement through the OFA but also have the ability to gain foundational skills and competencies to eventually serve as OFA leaders. This workshop provides an early exposure to the OFA for trainees and an opportunity to realize a potential career in academic medicine beyond the faculty role.

BackgroundApproximately half of hypertrophic cardiomyopathy (HCM) patients lack a precise genetic diagnosis. The likelihood of identifying clinically relevant variants increased over time.MethodsIn this study, we conducted a gene-centric reanalysis of exome data of 200 HCM cases 5 years after the initial analysis. This reanalysis prioritized genes with a matched HCM entry in the OMIM database and recently emerging HCM-associated genes gathered using a text mining-based literature review. Further classification of the identified genes and variants was performed using the Clinical Genome Resource (ClinGen) resource and American College of Medical Genetics and Genomics (ACMG) guidelines to assess the robustness of gene–disease association and the clinical actionability of the prioritized variants.ResultsAs expected, the majority of patients carried variants in MYBPC3 and MYH7 genes, 26% (n = 51) and 8% (n = 16), respectively, in accordance with the initial analysis. The vast majority of pathogenic (P) and likely pathogenic (LP) variants were found in MYBPC3 (22 out of 40 variants) and MYH7 (8 out of 16 variants) genes. Three genes—not included in the initial analysis—were identified: SVIL, FHOD3, and TRIM63. Considering only patients with unique variants in the last three genes, there was a 9% enhancement in variant identification. Importantly, SVIL variant carriers presented apical and septal HCM, aortopathies, and severe scoliosis for one patient. Ten patients (5%) carried variants in the FHOD3 gene, six in hotspot regions (exons 12 and 15). We identified seven variants within the TRIM63 gene in 12 patients (6%). Homozygous variants were detected in 2.5% of the cohort in MYBPC3 (n = 1), MYL3 (n = 1), and TRIM63 (n = 3) genes.ConclusionOur study revealed that no variants were found in the ACTC1, TPM1, and TNNI3 genes in the HYPERGEN cohort. However, we identified variants in five out of the eight HCM core genes, with a high prevalence in young patients. We identified variants in three recent HCM-associated genes (SVIL, FHOD3, and TRIM63) in 35 patients, with 18 patients carrying unique variants (9%). Our results further emphasize the usefulness of exome data reanalysis, particularly in genotype-negative patients.

Abstract Background Structural income inequality – the uneven income distribution across regions or countries – could affect brain structure and function, beyond individual differences. However, the impact of structural income inequality on the brain dynamics and the roles of demographics and cognition in these associations remains unexplored. Methods Here, we assessed the impact of structural income inequality, as measured by the Gini coefficient on multiple EEG metrics, while considering the subject‐level effects of demographic (age, sex, education) and cognitive factors. Resting‐state EEG signals were collected from a diverse sample (countries = 10; healthy individuals = 1394 from Argentina, Brazil, Colombia, Chile, Cuba, Greece, Ireland, Italy, Turkey and United Kingdom). Complexity (fractal dimension, permutation entropy, Wiener entropy, spectral structure variability), power spectral and aperiodic components (1/f slope, knee, offset), as well as graph‐theoretic measures were analysed. Findings Despite variability in samples, data collection methods, and EEG acquisition parameters, structural inequality systematically predicted electrophysiological brain dynamics, proving to be a more crucial determinant of brain dynamics than individual‐level factors. Complexity and aperiodic activity metrics captured better the effects of structural inequality on brain function. Following inequality, age and cognition emerged as the most influential predictors. The overall results provided convergent multimodal metrics of biologic embedding of structural income inequality characterised by less complex signals, increased random asynchronous neural activity, and reduced alpha and beta power, particularly over temporoposterior regions. Conclusion These findings might challenge conventional neuroscience approaches that tend to overemphasise the influence of individual‐level factors, while neglecting structural factors. Results pave the way for neuroscience‐informed public policies aimed at tackling structural inequalities in diverse populations.

Over the past decades, advances in medical technology and research have promoted the globalization of medicine, drawing medical students and physicians worldwide into seeking for better career and financial prospects, as well as enhanced clinical and research training abroad. The medical landscape in Brazil has been marked by significant challenges over the past years, particularly within the Unified Health System (SUS). Despite the expansion of medical schools and initiatives such as the Mais Médicos program arising as efforts to improve healthcare access and decrease regional inequalities in the country, such problems as under-resourced working environments, inadequate infrastructure, and unattractive financial compensation for both physician and research careers, have risen as persisting challenges. In the pursuit of improved conditions, the United States Medical Licensing Examination (USMLE) has emerged as an increasingly common pathway for those seeking to overcome these challenges. This review explores the motivations behind Brazilians pursuing the USMLE while examining structural and financial challenges within the country’s medical education and SUS landscape.

Summary: Background: The HVTN 705 Imbokodo trial of 2636 people without HIV and assigned female sex at birth, conducted in southern Africa, evaluated a heterologous HIV-1 vaccine regimen: mosaic adenovirus 26-based vaccine (Ad26.Mos4.HIV) at Months 0, 3, 6, 12 and alum-adjuvanted clade C gp140 at Months 6, 12. Per-protocol vaccine efficacy (VE) against HIV-1 diagnosis from seven to 24 months was 14.1% (95% CI: −22.0% to 39.5%). Immune correlates analysis was performed for markers selected based on prior evidence in efficacy trials and/or nonhuman primate models. Methods: Humoral and cellular immune response markers at Month 7 were evaluated as immune correlates of risk and of protection in a breakthrough case–control cohort (n = 52 cases, 246 non-cases). Primary markers were IgG binding to vaccine-strain gp140, IgG3 binding to diverse Env antigens (IgG3 Env breadth), IgG3 binding to diverse V1V2 antigens (IgG3 V1V2 breadth), antibody-dependent phagocytosis against the vaccine-strain gp140, Env-specific CD4+ and CD8+ T-cell responses, and multi-epitope functions. Findings: No immune markers were statistically significant correlates of risk. IgG3 V1V2 breadth trended toward an inverse association: hazard ratio 0.70 (95% CI: 0.36 to 1.35; p = 0.29) per 10-fold increase and 0.51 (95% CI: 0.21 to 1.24; p = 0.14) in a Cox model with all primary markers. The VE estimate was 11.8% (95% CI: −17.9% to 34.0%) at all IgG3 V1V2 breadth values below 667 weighted geometric mean net MFI; just above this value, the VE estimate sharply increased to 62.6% (95% CI: −17.9% to 89.6%), and further increased to 80.9% (95% CI: −17.9% to 99.5%) at 1471 MFI, the 95th percentile of the marker distribution. Mediation analysis yielded a VE of 35.7% (95% CI: 15.0% to 51.3%) attributable to the vaccine's impact on this marker. Interpretation: The trend in association of greater IgG3 V1V2 antibody breadth with lower likelihood of HIV acquisition is consistent with the identification of antibodies against V1V2 as immune correlates in three other HIV vaccine efficacy trials and suggests that a greater emphasis should be placed on studying this region in the HIV-1 envelope as a vaccine immunogen. Funding: National Institute of Allergy and Infectious Diseases and Janssen Vaccines & Prevention BV.

Introducción: La importancia del conocimiento del impacto del trabajo en la salud de las personas se ha acrecentado tras la pandemia por COVID-19. El síndrome de Burn Out (BO) nace de la tensión emergente de la interacción conflictiva entre el trabajador y su empleo. El objetivo fue describir la prevalencia y frecuencia de diagnóstico del BO en el recurso humano en salud de servicios críticos del Hospital Municipal de Bahía Blanca en el contexto de la pandemia COVID-19. Métodos: Estudio descriptivo, de corte transversal. La población de estudio fue el personal médico y de enfermería de los servicios de Terapia intensiva (TI), Médico de Urgencias (SMU) y Clínica que trabajaron con COVID-19 durante el 2021. Se empleó el cuestionario Maslach Burnout Inventory (MBI) y preguntas cerradas complementarias para identificar, entre estos casos, aquellos que fueron diagnosticados y tratados por la institución. Resultados: De los 219 trabajadores, el 55,3% (121/219) fueron enfermeros. En el SMU el 25% (24/96) de encuestados tenía BO, seguido por un 20,4% (11/54) en Clínica y un 8.7% (6/69) en TI (valor p=0.004). Sólo el 5,5% (12/219) del total fue diagnosticado con BO por la institución y de este grupo, dos personas (0,9%) habían consultado previamente por síntomas característicos. Discusión: Se evidenció una elevada prevalencia de BO y un marcado sub-diagnóstico a nivel institucional durante la pandemia. A pesar de que el Servicio de TI tuvo la mayor demanda de atención, fue el que presentó los valores más bajos de BO en relación a otros servicios.

BackgroundAn integration of digital medicine into medical education can help future physicians shape the digital transformation of medicine. ObjectiveWe aim to describe and evaluate a newly developed course for teaching digital medicine (the Bielefeld model) for the first time. MethodsThe course was held with undergraduate medical students at Medical School Ostwestfalen-Lippe at Bielefeld University, Germany, in 2023 and evaluated via pretest-posttest surveys. The subjective and objective achievement of superordinate learning objectives and the objective achievement of subordinate learning objectives of the course, course design, and course importance were evaluated using 5-point Likert scales (1=strongly disagree; 5=strongly agree); reasons for absences were assessed using a multiple-choice format, and comments were collected. The superordinate objectives comprised (1) the understanding of factors driving the implementation of digital medical products and processes, (2) the application of this knowledge to a project, and (3) the empowerment to design such solutions in the future. The subordinate objectives comprised competencies related to the first superordinate objective. ResultsIn total, 10 undergraduate medical students (male: n=4, 40%; female: n=6, 60%; mean age 21.7, SD 2.1 years) evaluated the course. The superordinate objectives were achieved well to very well—the medians for the objective achievement were 4 (IQR 4-5), 4 (IQR 3-5), and 4 (IQR 4-4) scale units for the first, second, and third objectives, respectively, and the medians for the subjective achievement of the first, second, and third objectives were 4 (IQR 3-4), 4.5 (IQR 3-5), and 4 (IQR 3-5) scale units, respectively. Participants mastered the subordinate objectives, on average, better after the course than before (presurvey median 2.5, IQR 2-3 scale units; postsurvey median 4, IQR 3-4 scale units). The course concept was rated as highly suitable for achieving the superordinate objectives (median 5, IQR 4-5 scale units for the first, second, and third objectives). On average, the students strongly liked the course (median 5, IQR 4-5 scale units) and gained a benefit from it (median 4.5, IQR 4-5 scale units). All students fully agreed that the teaching staff was a strength of the course. The category positive feedback on the course or positive personal experience with the course received the most comments. ConclusionsThe course framework shows promise in attaining learning objectives within the realm of digital medicine, notwithstanding the constraint of limited interpretability arising from a small sample size and further limitations. The course concept aligns with insights derived from teaching and learning research and the domain of digital medicine, albeit with identifiable areas for enhancement. A literature review indicates a dearth of publications pertaining to analogous courses in Germany. Future investigations should entail a more exhaustive evaluation of the course. In summary, this course constitutes a valuable contribution to incorporating digital medicine into medical education.

Introduction: Prevention of diabetes requires sustained lifestyle changes as well as identification of groups at higher risk. Objective: The aim of this research was to estimate the risk of diabetes in vulnerable subjects from a primary care center in northern Argentina, with no known glucose abnormalities, using the FINDRISC questionnaire, investigate the relationship between survey variables and the final score, and explore its association with metabolic risk factors and body composition. Methodology: This cross-sectional design included 498 patients without type 2 diabetes or known glycemic abnormalities. All subjects underwent a complete medical history and completed the FINDRISC questionnaire. Results: The predominant age group was 18-45 years old. Around 64% were physically active and 44% reported daily consumption of fruit and vegetables. Most of them had a BMI higher than 25 kg/m2. Regarding the risk of developing type 2 diabetes in the next 10 years, 24.3% were at low risk and the remaining fraction was distributed in slightly elevated, moderate, high and very high risk. All variables influenced the individuals' variance (p < 0.05). The hierarchical clustering and principal component analysis (PCA) revealed that elevated FINDRISC score was strongly associated with: age > 65 years, fasting blood glucose, BMI ? 30 kg/m2 and antihypertensives use. CONCLUTION: We found a high percentage of obesity and overweight, as well as a high risk of cardiometabolic disease and of developing T2D. In addition, in the population studied, the variables that compose the FINDRISC did not influence the highest score in the same way.

Summary: Background: Timely and economic provision of revascularisation procedures is a major healthcare need. We aimed to examine the safety and efficacy of daycase-based lower extremity endovascular revascularisation procedures in patients with peripheral artery disease. Methods: In this systematic review and meta-analysis, we searched MEDLINE and Embase for studies from Jan 01, 2000 through Apr 01, 2024 reporting complications of lower limb endovascular revascularisation procedures with same-day discharge. Eligibility-criteria, complications, and patient characteristics were extracted, methodological quality assessed (adapted Newcastle–Ottawa Scale), and meta-analyses of complications and technical success performed to provide pooled estimates. This study is registered with PROSPERO, CRD42022316466. Findings: Thirty observational studies (17 retrospective, 13 prospective) and 1 RCT reported 2427 minor and 653 major complications after 99,600 daycase procedures (93,344 patients). Eighteen studies reported daycase eligibility-criteria including ‘responsible adult companion’ (78%), ‘proximity to hospital’, and ‘telephone availability’ and excluding unstable and severe co-morbidities, offset coagulation, and severe chronic kidney disease. Pooled incidences of minor (4.7% [95% CI 3.8–5.6%], I2 = 96%) and major (0.64% [95% CI 0.48–0.79%], I2 = 46%) complications were low and technical success high (93% [95% CI 91–96%], I2 = 97%). Most complications were related to the puncture site. Pooled conversion-to-hospitalisation rates and re-admission after discharge were 1.6% (95% CI 1.1–2.2%, I2 = 82%) and 0.11% (95% CI 0.095–0.23%, I2 = 97%), respectively. Meta-regression identified that minor complications decreased since 2000. Male sex and coronary artery disease were associated with more frequent, and higher age and closure device use with less minor complications. Diabetes mellitus and chronic kidney disease were associated with less major complications. Six studies reported complication rates both in daycases and inpatients and there was no significant difference (−0.8% [95% CI −1.9 to 0.3%]). Interpretation: After careful evaluation of eligibility, lower limb angioplasty can be performed safely with high technical success in a daycase setting. Most complications arise from the puncture site and not the procedure itself highlighting the importance of optimal access site management. The heterogeneity between studies warrants standardised monitoring of complications and outcomes. Funding: European Partnership on Metrology, co-financed from European Union’s Horizon Europe Research and Innovation Programme and UK Research and Innovation, and Medical Research Council.

BackgroundActinic keratosis (AK) is a highly prevalent pre-cancerous skin lesion that often leads to cutaneous squamous cell carcinoma. There are different stages of evolution of the disease and several features that characterize keratosis. This study aimed to develop a qualitative and quantitative visual diagnostic tool to facilitate the identification of the characteristics and severity of the main cellular attributes of AK and to show its applicability in evaluating the evolution or treatment through image analysis.MethodsLiterature research on the main scientific databases and in the institute’s database was carried out to gather all the different levels of cellular transformation. To validate the scale, a preliminary characterization study was carried out with 21 subjects who had clinically diagnosed AK lesions to classify the attributes in each skin layer and test the accuracy of the diagnosis of the scale. Afterward, and to show the possibility of a follow-up with a topical treatment, the subjects were divided into two treatment groups, receiving either a cream formulation containing retinoic acid, or a placebo formula. The evaluation was carried out through confocal reflectance microscopy and a digital camera with dermoscopic quality before and after 90 days of treatment.ResultsA table detailing the 18 attributes of AK, and a photographic scale containing RCM images graded by scores established for each characteristic and the frequency of spreading were developed. The results of the validation presented good repeatability, correlation with clinical evaluation, and capacity for differentiating treatments demonstrated by the significant improvement after topical treatment by the reduction of the score for 10 out of the 18 attributes. The preliminary study, evaluated by the detailed transformation scale highlights important differences in the subclinical approach that allows a deeper evaluation of the aspects of the lesion’s re-incidence even after fully treated skin sites.ConclusionThis study brings an innovative method based on RCM, to assist in the quantification of cell transformation level, provide early diagnosis, and deliver a powerful treatment evaluation tool to provide smoother treatment, as well as prevent re-incidence in the cases.

Summary: Background: Bacille Calmette-Guérin (BCG) vaccination has off-target (non-specific) effects that are associated with protection against unrelated infections and decreased all-cause mortality in infants. We aimed to determine whether BCG vaccination prevents febrile and respiratory infections in adults. Methods: This randomised controlled phase 3 trial was done in 36 healthcare centres in Australia, Brazil, the Netherlands, Spain, and the United Kingdom. Healthcare workers were randomised to receive BCG-Denmark (single 0.1 ml intradermal injection) or no BCG in a 1:1 ratio using a web-based procedure, stratified by stage, site, age, and presence of co-morbidity. The difference in occurrence of febrile or respiratory illness were measured over 12 months (prespecified secondary outcome) using the intention-to-treat (ITT) population. This trial is registered with ClinicalTrials.gov, NCT04327206. Findings: Between March 30, 2020, and April 1, 2021, 6828 healthcare workers were randomised to BCG-Denmark (n = 3417) or control (n = 3411; no intervention or placebo) groups. The 12-month adjusted estimated risk of ≥1 episode of febrile or respiratory illness was 66.8% in the BCG group (95% CI 65.3%–68.2%), compared with 63.4% in the control group (95% CI 61.8%–65.0%), a difference of +3.4 percentage points (95% CI +1.3% to +5.5%; p 0.002). The adjusted estimated risk of a severe episode (defined as being incapacitated for ≥3 consecutive days or hospitalised) was 19.4% in the BCG group (95% CI 18.0%–20.7%), compared with 18.8% in the control group (95% CI 17.4%–20.2%) a difference of +0.6 percentage points (95% CI −1.3% to +2.5%; p 0.6). Both groups had a similar number of episodes of illness, pneumonia, and hospitalisation. There were three deaths, all in the control group. There were no safety concerns following BCG vaccination. Interpretation: In contrast to the beneficial off-target effects reported following neonatal BCG in infants, a small increased risk of symptomatic febrile or respiratory illness was observed in the 12 months following BCG vaccination in adults. There was no evidence of a difference in the risk of severe disease. Funding: Bill & Melinda Gates Foundation, Minderoo Foundation, Sarah and Lachlan Murdoch, the Royal Children's Hospital Foundation, Health Services Union NSW, the Peter Sowerby Foundation, SA Health, the Insurance Advisernet Foundation, the NAB Foundation, the Calvert-Jones Foundation, the Modara Pines Charitable Foundation, the UHG Foundation Pty Ltd, Epworth Healthcare, the National Health and Medical Research Council, the Swiss National Science Foundation and individual donors.

Paulo Cruchinho,1 María Dolores López-Franco,2 Manuel Luís Capelas,3 Sofia Almeida,4 Phillippa May Bennett,5– 7 Marcelle Miranda da Silva,1,8 Gisela Teixeira,1 Elisabete Nunes,1 Pedro Lucas,1 Filomena Gaspar1 On Behalf of the Handovers4SafeCare1Nursing Research, Innovation and Development Center (CIDNUR) of Lisbon, Nursing School of Lisbon, Lisboa, Portugal; 2CTS-464 Nursing and Innovation in Healthcare, University of Jaén, Jaén, Spain; 3Universidade Católica Portuguesa, Faculty of Health Sciences and Nursing, Center for Interdisciplinary Research in Health (CIIS), Lisboa, Portugal; 4Universidade Católica Portuguesa, Faculty of Health Sciences and Nursing, Center for Interdisciplinary Research in Health (CIIS), Porto, Portugal; 5Center for English, Translation, and Anglo-Portuguese Studies (CETAPS), Lisboa, Portugal; 6Faculty of Social Sciences and Humanities of the New University of Lisbon, Lisboa, Portugal; 7Faculty of Arts and Humanities of the University of Coimbra, Department of Languages, Literatures and Cultures, Coimbra, Portugal; 8Federal University of Rio de Janeiro, Anna Nery Nursing School, Rio de Janeiro, BrazilCorrespondence: Paulo Cruchinho, Nursing School of Lisbon, Avenida Prof. Egas Moniz, Lisboa, 1600-190, Portugal, Tel +351 217913400, Email pjcruchinho@esel.ptAbstract: Cross-cultural validation of self-reported measurement instruments for research is a long and complex process, which involves specific risks of bias that could affect the research process and results. Furthermore, it requires researchers to have a wide range of technical knowledge about the translation, adaptation and pre-test aspects, their purposes and options, about the different psychometric properties, and the required evidence for their assessment and knowledge about the quantitative data processing and analysis using statistical software. This article aimed: 1) identify all guidelines and recommendations for translation, cross-cultural adaptation, and validation within the healthcare sciences; 2) describe the methodological approaches established in these guidelines for conducting translation, adaptation, and cross-cultural validation; and 3) provide a practical guideline featuring various methodological options for novice researchers involved in translating, adapting, and validating measurement instruments. Forty-two guidelines on translation, adaptation, or cross-cultural validation of measurement instruments were obtained from “CINAHL with Full Text” (via EBSCO) and “MEDLINE with Full Text”. A content analysis was conducted to identify the similarities and differences in the methodological approaches recommended. Bases on these similarities and differences, we proposed an eight-step guideline that includes: a) forward translation; 2) synthesis of translations; 3) back translation; 4) harmonization; 5) pre-testing; 6) field testing; 7) psychometric validation, and 8) analysis of psychometric properties. It is a practical guideline because it provides extensive and comprehensive information on the methodological approaches available to researchers. This is the first methodological literature review carried out in the healthcare sciences regarding the methodological approaches recommended by existing guidelines.Keywords: cross-cultural comparison, decision-making, psychometric properties, research design, validation studies, health services research

Abstract Background Based on previous in vivo studies and human trials, intrathecal cell delivery is a safe and relevant therapeutic tool for improving patient's quality of life with neurological conditions. We aimed to characterise the safety profile of intrathecally delivered Mesenchymal stem cells (MSCs). Methods Ovid MEDLINE, Embase, Scopus, Cochrane Library, KCI-Korean Journal Database, and Web of Science. Databases were searched from their inception until April 13, 2023. Randomised Controlled Trials (RCTs) that compared intrathecal delivery of MSCs to controls in adult populations were included. Adverse events (AEs) were pooled and meta-analysed using DerSimonian-Laird random effects models with a correction factor 0.5 added to studies with zero count cells. Pooled AEs were described using Risk ratio (RR) and 95% confidence intervals (95% CI). Then, a random-effects meta-regress model on study-level summary data was performed to explore the relationship between the occurrence of AEs and covariates thought to modify the overall effect estimate. Finally, publication bias was assessed. Results 303 records were reviewed, and nine RCTs met the inclusion criteria and were included in the quantitative synthesis (n = 540 patients). MSCs delivered intrathecally, as compared to controls, were associated with an increased probability of AEs of musculoskeletal and connective tissue disorders (categorised by Common Terminology Criteria for Adverse Events—CTCAE version 5.0) (RR: 1.61, 95% CI 1.19–2.19, I2 = 0%). The random-effects meta-regress model suggested that fresh MSCs increased the probability of occurrence of AEs compared to cryopreserved MSCs (RR: 1.554; p-value = 0.048; 95% CI 1.004–2.404), and the multiple-dose, decreased the probability of AEs by 36% compared to single doses (RR: 0.644; p-value = 0.048; 95% CI 0.416–0.996); however, univariate random effects meta-regression models revealed a not significant association between the occurrence of AEs from MSCs intrathecal delivery and each covariate. Conclusions Intrathecal delivery of MSCs was associated with a slight increase in AEs associated with musculoskeletal and connective tissue disorders, albeit without serious AEs. We conclude that intrathecal MSCs delivery is safe for patients with neurological conditions. However, further high-quality, large-scale RCTs are needed to confirm these findings.

Abstract Background The E-value, a measure that has received recent attention in the comparative effectiveness literature, reports the minimum strength of association between an unmeasured confounder and the treatment and outcome that would explain away the estimated treatment effect. This study contributes to the literature on the applications and interpretations of E-values by examining how the E-value is impacted by data with varying levels of association of unobserved covariates with the treatment and outcome measure when covariate adjustment is applied. We calculate the E-value after using regression and propensity score methods (PSMs) to adjust for differences in observed covariates. Propensity score methods are a common observational research method used to balance observed covariates between treatment groups. In practice, researchers may assume propensity score methods that balance treatment groups across observed characteristics will extend to balance of unobserved characteristics. However, that assumption is not testable and has been shown to not hold in realistic data settings. We assess the E-value when covariate adjustment affects the imbalance in unobserved covariates. Methods Our study uses Monte Carlo simulations to evaluate the impact of unobserved confounders on the treatment effect estimates and to evaluate the performance of the E-Value sensitivity test with the application of regression and propensity score methods under varying levels of unobserved confounding. Specifically, we compare observed and unobserved confounder balance, odds ratios of treatment vs. control, and E-Value sensitivity test statistics from generalized linear model (GLM) regression models, inverse-probability weighted models, and propensity score matching models, over correlations of increasing strength between observed and unobserved confounders. Results We confirm previous findings that propensity score methods – matching or weighting – may increase the imbalance in unobserved confounders. The magnitude of the effect depends on the strength of correlation between the confounder, treatment, and outcomes. We find that E-values calculated after applying propensity score methods tend to be larger when unobserved confounders result in more biased treatment effect estimates. Conclusions The E-Value may misrepresent the size of the unobserved effect needed to change the magnitude of the association between treatment and outcome when propensity score methods are used. Thus, caution is warranted when interpreting the E-Value in the context of propensity score methods.

Outdoor farming contributes to biodiversity conservation and enhances animal welfare, but also raises biosafety concerns due to livestock contact with potentially infected wildlife. Thus, there is a need to assess the balance between vertebrate species richness on farms, visits by wildlife species posing a biosafety risk, and pathogen circulation in open-air farming systems. We explored these links in a pilot study involving 15 open-air hoofstock farms (6 cattle, 5 small ruminant, and 4 pig farms), where we conducted interviews and risk point inspections and used two noninvasive tools: short-term camera trap (CT) deployment and environmental nucleic acid detection (ENAD). CTs were deployed to assess the richness of birds and mammals, as well as to determine the percentage of CTs detecting defined risk species. We also collected livestock feces and used sponges to sample surfaces for environmental DNA (eDNA), testing for nine pathogen markers. Total vertebrate richness ranged from 18 to 42 species, with waterholes significantly contributing to farm vertebrate richness, since 48.2 % of all wild vertebrates were detected at waterbodies, and 28.6 % were exclusively detected at waterholes. Pathogen markers detected at risk points correlated with those detected in livestock samples. Notably, the frequency of uidA marker detection correlated with the total number of pathogen markers detected per farm. Overall marker richness, an indicator of pathogen diversity, varied between farms, being higher in small ruminant farms compared to cattle or pig farms. At the farm level, wild vertebrate richness was negatively correlated with the richness of pathogen markers detected at risk points. Additionally, risk points with a higher probability of detecting more pathogen markers had lower vertebrate richness. Although CT-based assessments of vertebrate richness and ENAD-based pathogen marker detection are only indicators of actual biodiversity and farm health, respectively, our findings suggest that farmland vertebrate communities provide important ecosystem services and may help limit the circulation of multi-host pathogens.

To shed first light on caprine schistosomiasis and its zoonotic potential in Malawi, we conducted a molecular epidemiological investigation, sampling goats (n = 230) across three districts, using faecal miracidia hatching test. Molecular genotyping of miracidia later revealed the prevalence of Schistosoma mattheei to be 0.0 % in Nsanje District (n = 30), 16.7 % in Chikwawa District (n = 30) and 25.3 % in Mangochi District (n = 170). Notably, a miracidium of Schistosoma haematobium was observed from a single goat in Chikwawa. Inspection of carcasses (n = 51) at two local abattoirs in Mangochi District did not find any evidence of caprine schistosomiasis where only a single herd, at Mangochi 3, was infected. Here, despite sampling several other herds nearby, the prevalence was 87.7 % (n = 49), with an animal found excreting 1000 miracidia per 5 g of faeces. At this location, our praziquantel treatment (n = 14) and GPS animal tracking (n = 2) pilot sub-study compared two local goat herds over a three-month period. The daily foraging ranges across a 10 km2 area were recorded, alongside targeted schistosome surveillance within local freshwater intermediate snail hosts. Analysis of GPS data revealed only one herd (infected) to have regular daily water contact with Lake Malawi whereas the other herd (not infected) totally avoided the lake. One week after praziquantel treatment administered at 40 mg/kg, anthelminthic cure rate was 92.3 % while at three months approximately a third of treated animals were shedding schistosome miracidia. Cercariae from several field-caught snails locally were genotyped, inclusive of finding a Schistosoma haematobium-mattheei hybrid. Our findings reveal the focalized nature of caprine schistosomiasis, signposting a novel alert for S. haematobium transmission, and highlight where zoonotic transmission can be intense. To better address zoonotic spill-over from S. mattheei (and/or S. haematobium), the national control programme for schistosomiasis should formally develop targeted surveillance of caprine schistosomiasis and where appropriate, attempt an integrated One Health intervention in future.

Simulation-based training in computer-generated environments has always played an important role in clinical medical education. Recently, there has been a growing interest in using 360° videos of real-life situations for training in health professions. Several studies report positive results from using 360° Virtual Reality for individuals, yet there are currently no studies on collaborative 360° Virtual Reality training. In this paper, we evaluate how 360° Virtual Reality can support collaborative training in clinical medical education. The study population consisted of 14 medical students in semester 5 of their Bachelor’s programme. The students were divided into three groups before watching and annotating a 360° video of an authentic learning situation inside a collaborative immersive virtual reality space. The original video shows a problem-based examination of the collateral and cruciate ligaments of the knee performed by students under the supervision of a professor. After training in collaborative 360° Virtual Reality, students then had to perform the same tests in a physical examination. The students’ performance was subsequently evaluated by a professor with expertise in knee examinations. The results show that 12 out of 14 students received a score of 2 for one or more tests, thereby meeting the required learning objective. One student received a score of 1 and one student did not perform any of the tests. The students actively use the tools provided by the software and different communicative strategies when working collaboratively in 360° Virtual Reality, which enables them to perform the tests in the physical examination by transferring their constructed knowledge. The results indicate that our pedagogical design in collaborative immersive 360° Virtual Reality can become a relevant addition to face-to-face clinical medical training.

In Malawi, the putative origin of a newly described Schistosoma haematobium-mattheei hybrid human schistosome was assessed upon a seminal molecular parasitological survey of cattle. Using miracidia hatch test (MHT) and carcass inspection at slaughter, mean prevalence of bovine schistosomiasis was 49.1% (95% CI: 43.7–54.6%) and 10.3% (95% CI: 6.0–16.2%) respectively, though significant spatial heterogeneity was noted. Approximately 2.0% of infected cattle, and only those from Mangochi District, shed S. haematobium-mattheei and/or S. haematobium in faeces. To quantify schistosome (re)infection dynamics, where a S. haematobium-mattheei hybrid was present, we undertook a novel pilot GPS-datalogging sub-study within a specific herd of cattle (n = 8) on the Lake Malawi shoreline, alongside a praziquantel (40 mg/kg) treatment efficacy spot check. At sub-study baseline, all GPS-tagged cattle had proven daily water contact with the lake. Each animal was patently infected upon MHT, with older animals shedding less miracidia. At one month review, whilst parasitological cure was 100.0%, from six weeks onwards, (re)infection was first noted in the youngest animal. By three-month review, all animals were patently (re)infected though only miracidia of S. mattheei were recovered, albeit in much lower numbers. To conclude, infection with S. mattheei is particularly common in cattle and demonstrates a previously cryptic burden of bovine schistosomiasis. Within Mangochi District, bovine transmission of both S. haematobium-mattheei hybrids and S. haematobium are now incriminated, with unequivocal evidence of contemporary zoonotic spill-over. Future control of urogenital schistosomiasis here in the southern region needs to develop, then successfully integrate, a One Health approach with appropriate mitigating strategies to reduce and/or contain bovine schistosomiasis transmission.

The diversity and prevalence of canine vector-borne pathogens (VBPs) in Bhutan have to date remained unexplored, whilst recent epidemiological surveys in other South Asian nations have found diseases caused by VBPs to be rife in local dog populations. Importantly, many of such VBPs can infect people as well, with a building body of evidence identifying potentially zoonotic rickettsial organisms infecting humans in Bhutan. Given the lack of data on canine pathogens in Bhutan we employed a suite of deep-sequencing metabarcoding methods using Oxford Nanopore Technologies' MinION™ device to holistically characterise the bacterial, apicomplexan and filarial worm blood-borne pathogens of dogs in the country's south. Of the 95 stray, owned and community dogs sampled 78% (95% CI = 69%–85%) were infected with at least one VBP. Pathogen species detected were highly diverse including the bacteria Mycoplasma haemocanis in 16% (95% CI: 10–24%), Ehrlichia canis in 4% (95% CI: 2–10%), Anaplasma platys in 2% (95% CI: 0.5–7%) of dogs as well as the zoonotic species Bartonella clarridgeiae in 1% (95% CI: 0.1–6%), a potentially novel Bartonella spp. and an Ehrlichia chaffeensis-like bacterium, both in 1% (95% CI: 0.1–6%) of dogs. The apicomplexan haemoparasites Hepatozoon canis in 62% (95% CI: 52–71%), Babesia gibsoni in 45% (95% CI: 36–55%) and Babesia vogeli in 3% (95% CI: 1–9%) of dogs were also detected. Finally, 5% (95% CI: 2–12%) of dogs were found to be infected with the filarioid Acanthocheilonema reconditum and 1% (95% CI: 0.1–6%) with zoonotic Dirofilaria sp. hongkongensis. One canine was found positive to the filarioid Setaria tundra, a species normally found infecting cervids. The elucidated diversity of VBP communities highlights the strength of assumption-free diagnostics, such as metabarcoding, in detecting rare, novel, and unexpected pathogens. This approach to identifying pathogen diversity is of critical importance when investigating regions and populations that have thus far been neglected, with the findings aiding the development of future One Health informed strategies for disease control.

Objective: to investigate the emotional repercussions experienced by nursing professionals during the COVID-19 pandemic in Manaus. Method: qualitative descriptive study. Data collection took place from June 2020 to February 2021, in the Amazonas state capital, Brazil, through semi-structured interviews with nursing professionals who worked on the front line, coded with the aid of the ATLAS.ti 8.0 program and analyzed according to the precepts of Thematic Network Analysis. Results: the 19 participants were nurses (68%) and nursing technicians/assistants (32%). Four themes emerged from the Emotional Impacts Thematic Network: unexpected changes, increased tensions, emotional distress, and psychosocial support strategies. Conclusion: the professionals' experiences should be used as a basis for initiatives to promote and protect their health, as well as their working conditions, in order to guarantee the quality of the care they provide.

Objetivo: investigar as repercussões emocionais vivenciadas pelos profissionais de enfermagem durante o enfrentamento da pandemia de COVID-19 em Manaus. Método: estudo descritivo qualitativo. A coleta de dados ocorreu de junho de 2020 a fevereiro de 2021, na capital do estado do Amazonas, Brasil, por meio de entrevistas semiestruturadas com profissionais de enfermagem que atuaram na linha de frente, codificadas com o auxílio do programa ATLAS.ti 8.0 e analisadas segundo os preceitos da análise de Redes Temáticas. Resultados: os 19 participantes foram enfermeiros (68%) e técnicos/auxiliares de enfermagem (32%). Da Rede Temática Impactos Emocionais emergiram quatro temas: mudanças inesperadas, tensões ampliadas, sofrimento emocional e estratégias de suporte psicossocial. Conclusão: as experiencias vividas pelos profissionais devem ser subsídio para iniciativas que promovam e protejam a saúde desses profissionais, como também suas condições de trabalho para garantir a qualidade dos cuidados prestados.

Objetivo: investigar las repercusiones emocionales que experimentaron los profesionales de enfermería durante la pandemia de COVID-19 en Manaos. Método: estudio descriptivo cualitativo. La recolección de datos se realizó de junio de 2020 a febrero de 2021, en la capital del estado de Amazonas, Brasil, a través de entrevistas semiestructuradas con profesionales de enfermería que trabajaban en la primera línea, codificadas con ayuda del programa ATLAS.ti 8.0 y analizadas según los preceptos del análisis de Redes Temáticas. Resultados: los 19 participantes eran enfermeros (68%) y técnicos/auxiliares de enfermería (32%). De la Red Temática Impactos Emocionales surgieron cuatro temas: cambios inesperados, mayor tensión, sufrimiento emocional y estrategias de apoyo psicosocial. Conclusión: las experiencias de los profesionales deben contribuir a la creación de iniciativas que promuevan y protejan la salud y las condiciones de trabajo de dichos profesionales, para garantizar la calidad de la atención que brindan.

Objetivo: Evaluar la viabilidad de descontaminar los respiradores PFF2 en situaciones pandémicas. Método: Cuasi experimento, en un hospital público del sur de Brasil, entre abril y junio de 2021. La muestra consistió en respiradores PFF2 utilizados durante seis y 42 horas en la unidad de cuidados intensivos, divididos en grupos (tiempo de uso y tipos de intervención) y un grupo de control. Se evaluó su resistencia, integridad e inflamabilidad. Se utilizaron estadísticas descriptivas e inferenciales para comparar varios grupos y comprobar si el respirador seguía siendo seguro de usar tras la descontaminación, entre los distintos tratamientos y el tiempo de uso de las mascarillas. Resultados: Hubo una diferencia significativa en la eficacia del filtro (p=0,002) y la resistencia (p

Objetivo: Avaliar a viabilidade da descontaminação de respiradores PFF2, em situações de pandemia. Método: Quase-experimento, em hospital público do Sul do Brasil, entre abril e junho de 2021. A amostra foi de respiradores PFF2 usados por seis e 42 horas no centro de terapia intensiva, divididos em grupos (tempo de uso e tipos de intervenção) e grupo controle. Foram avaliados quanto a resistência, integridade e inflamabilidade. Foi utilizada estatística descritiva e inferencial na comparação de múltiplos grupos para verificar se o respirador permanecia seguro para o uso após a descontaminação, entre os diferentes tratamentos e o tempo de uso das máscaras. Resultados: Houve diferença significativa da eficiência do filtro (p=0,002) e da resistência (p

Objetivo: mapear las estrategias para la enseñanza de estudiantes universitarios con trastorno por déficit de atención con hiperactividad e identificar las estrategias recomendadas para la enseñanza de estos estudiantes que cursan la licenciatura en enfermería. Método: se trata de una revisión de alcance. Realizada en diciembre de 2023 en seis bases de datos y en el catálogo de tesis y disertaciones. Resultados: la selección resultó en 14 estudios. Las estrategias mapeadas se clasificaron en generales y activas, entre ellas: tiempo extra y flexibilización de horario para realizar evaluaciones; y aprendizaje basado en problemas. Ya en el contexto de la enfermería: promover un mejor proceso de comunicación, organización y priorización de actividades durante la práctica clínica. Conclusión: es fundamental reconocer que el trastorno por déficit de atención con hiperactividad puede estar presente en el estudiante universitario. Luego, es necesario que las instituciones de educación superior reflexionen sobre las estrategias de enseñanza inclusivas para este público objetivo.

Objective: to map strategies for teaching university students with attention deficit hyperactivity disorder and identify recommended strategies for teaching these students pursuing a degree in nursing. Method: this is a scoping review. Conducted in December 2023 in six databases and the catalog of theses and dissertations. Results: the selection resulted in 14 studies. The mapped strategies were classified as general and active: extra time and flexible scheduling to conduct assessments and problem-based learning. In nursing, promoting better communication, organization, and prioritization of activities during clinical practice is necessary. Conclusion: it is essential to recognize that attention deficit hyperactivity disorder may be present in university students. Therefore, higher education institutions must reflect on inclusive teaching strategies for this target audience.

Objetivo: Mapear as estratégias para o ensino de estudantes universitários com transtorno do déficit de atenção com hiperatividade e identificar as estratégias recomendadas para o ensino desses estudantes que cursam a graduação em enfermagem. Método: Trata-se de uma revisão de escopo, realizada em dezembro de 2023, em seis bases de dados e no catálogo de teses e dissertações. Resultados: A seleção resultou em 14 estudos. As estratégias mapeadas foram classificadas em gerais e ativas, entre elas: tempo extra e flexibilização de horário para realizar avaliações; e, aprendizagem baseada em problemas. Já, no contexto da enfermagem, tem-se: promover melhor processo de comunicação, organização e priorização de atividades durante a prática clínica. Conclusão: É fundamental reconhecer que o transtorno do déficit de atenção com hiperatividade pode estar presente no estudante universitário. Logo, é necessário que as instituições de ensino superior reflitam sobre as estratégias de ensino inclusivas para esse público-alvo.

Objective: Evaluate the feasibility of decontaminating PFF2 respirators in pandemic situations. Method: Quasi-experiment in a public hospital in South Brazil between April and June 2021. The sample consisted of PFF2 respirators used for six and 42 hours in the intensive care unit, divided into groups (usage time and types of intervention) and a control group. They were evaluated for resistance, integrity, and flammability. Descriptive and inferential statistics were used to compare multiple groups to verify whether the respirator remained safe after decontamination, among the different treatments and the mask usage time. Results: There was a significant difference in filter efficiency (p=0.002) and resistance (p

Summary: Background: Studies on DNA methylation following bariatric surgery have primarily focused on blood cells, while it is unclear to which extend it may reflect DNA methylation profiles in specific metabolically relevant organs such as adipose tissue. Here, we investigated whether adipose tissue depots specific methylation changes after bariatric surgery are mirrored in blood. Methods: Using Illumina 850K EPIC technology, we analysed genome-wide DNA methylation in paired blood, subcutaneous and omental visceral AT (SAT/OVAT) samples from nine individuals (N = 6 female) with severe obesity pre- and post-surgery. Findings: The numbers and effect sizes of differentially methylated regions (DMRs) post-bariatric surgery were more pronounced in AT (SAT: 12,865 DMRs from −11.5 to 10.8%; OVAT: 14,632 DMRs from −13.7 to 12.8%) than in blood (9267 DMRs from −8.8 to 7.7%). Cross-tissue DMRs implicated immune-related genes. Among them, 49 regions could be validated with similar methylation changes in blood from independent individuals. Fourteen DMRs correlated with differentially expressed genes in AT post bariatric surgery, including downregulation of PIK3AP1 in both SAT and OVAT. DNA methylation age acceleration was significantly higher in AT compared to blood, but remained unaffected after surgery. Interpretation: Concurrent methylation pattern changes in blood and AT, particularly in immune-related genes, suggest blood DNA methylation mirrors AT's inflammatory state post-bariatric surgery. Funding: The funding sources are listed in the Acknowledgments section.

Introduction: The use of electronic cigarettes (e-cigarettes) has increased in Brazil. Objective: To assess the prevalence of e-cigarette use and the factors associated with its use among college students. Methods: This is a cross-sectional observational study, carried out with undergraduate students from two private colleges. The prevalence of the consumption of e-cigarettes, conventional cigarettes, alcohol and marijuana was evaluated. The motivations for initiating e-cigarette use and the respondents' perceptions about their use were also reported. Results: 518 undergraduate students were evaluated, with a mean age of 23±5.7 years, 64.09% were female and 60.42% were medical students. The prevalence of e-cigarette use was 24.32%, and the highest consumption occurred in medical school. The main motivations for starting the use of e-cigarettes were curiosity (47.70%), and the influence of friends and/or family (31.61%). Advancing age and being employed reduced the chance of using e-cigarettes by 7% and 67%, respectively, while higher family income increased the chance of e-cigarette use by 28%. The use of conventional cigarettes, alcohol and marijuana increased this chance by 6.4; 11.8 and 3.7 times, respectively. Conclusion: The high prevalence of e-cigarette use among undergraduate students stands out. The main reasons to start e-cigarette use were curiosity, and the influence of friends and/or family. Further, e-cigarette use was associated with age, family income, being employed, use of conventional cigarettes, alcohol and marijuana. Due to the high prevalence of e-cigarette use among Brazilian undergraduate students, higher education institutions should initiate awareness campaigns that communicate the health risks linked to their use.

Background Errors associated with failures in filing, actioning and communicating blood test results can lead to delayed and missed diagnoses and patient harm. This study aimed to audit how blood tests in primary care are filed, actioned and communicated in primary care, to identify areas for patient safety improvements.Methods UK primary care clinicians were recruited through the Primary Care Academic CollaboraTive (PACT). PACT members audited 50 recent sets of blood tests from their practice and retrospectively extracted data on blood test result coding, actioning and communication. PACT members received a practice report, showing their own results, benchmarked against other participating practices.Results PACT members from 57 general practices across all four UK nations collected data on 2572 patients who had blood tests in April 2021. In 89.9% (n=2311) they agreed with the initial clinician’s actioning of blood tests; 10.1% disagreed, either partially (7.1%) or fully (3.0%).In 44% of patients (n=1132) an action (eg, ‘make an appointment’) was specified by the filing clinician. This action was carried out in 89.7% (n=1015/1132) of cases; in 6.8% (n=77) the action was not carried out, in 3.5% (n=40) it was unclear. In the 117 cases where the test result had not been actioned 38% (n=45) were felt to be at low risk of harm, 1.7% (n=2) were at high risk of harm, 0.85% (n=1) came to harm.Overall, in 47% (n=1210) of patients there was no evidence in the electronic health records that results had been communicated. Out of 1176 patients with one or more abnormal results there was no evidence of test communication in 30.6% (n=360). There were large variations between practices in rates of actioning and communicating tests.Conclusion This research demonstrates variation in the way blood test results are actioned and communicated, with important patient safety implications.

ContextCOVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly.ObjectivesTo describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves.MethodsThis retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG).ResultsOut of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p

Introdução: No processo de edificação da Política Nacional de Saúde Integral LGBT+, a Atenção Básica ganha importante destaque, pois deveria funcionar como o contato preferencial dos usuários transgênero (trans). Objetivo: Investigar quais as percepções dos profissionais da Atenção Básica quanto às situações de vulnerabilidade enfrentadas pelas pessoas trans, bem como pesquisar os impedimentos que eles consideram existir na busca dessa população por acesso a esses serviços. Métodos: Utilizou-se uma abordagem qualitativa por meio de entrevistas semiestruturadas com 38 profissionais de saúde atuantes das Estratégias Saúde da Família de dois municípios do interior do estado de São Paulo. O material obtido foi submetido à análise de conteúdo de Bardin. Resultados: Os resultados apontaram para o desconhecimento quanto aos reais empecilhos que dificultam o acesso e seguimento de pessoas trans nos serviços de saúde. Observou-se ainda a manutenção de preconceitos e ideias que reforçam estereótipos ligados ao tema e que se estendem ao exercício da profissão. Isso se relaciona diretamente com a falta da abordagem de assuntos relacionados à sexualidade humana na graduação desses profissionais, além da falta de atualização quanto ao tema, o que impacta a qualidade do serviço que é ofertado à população em estudo. Conclusões: As normativas e portarias já existentes precisam ser efetivamente postas em prática, fazendo-se imperativas a ampliação e difusão do conhecimento a respeito da temática trans no contexto dos serviços públicos de saúde, o que pode servir como base para subsidiar a formação dos profissionais que atuam nesse setor, bem como políticas públicas efetivas.

Objetivo: Descrever a mortalidade materna nas macrorregiões de saúde de Mato Grosso do Sul no período de 2011 a 2019. Métodos: Estudo descritivo e transversal de casos notificados de mortalidade materna no estado de Mato Grosso do Sul e suas macrorregiões de saúde, no período de 2011 a 2019. Foram extraídos por meio do acesso a fonte de dados do Sistema de Informações sobre Mortalidade. Os dados de faixa etária, escolaridade, cor, estado civil, local de ocorrência, causa e período gravídico-puerperal foram armazenados no software Microsoft Excel. A Razão de Mortalidade Materna foi calculada para cada macrorregião. Resultados: Foram identificados 237 óbitos maternos, com 46,0% na macrorregião de Campo Grande, 32,5% em Dourados, 11,4% em Três lagoas e 10,1% em Corumbá. Foram registrados 391.171 nascidos vivos no estado de Mato Grosso do Sul e o coeficiente de mortalidade materna nesse período foi de 60,6/100.000 nascidos vivos. Conclusão: Os números de mortalidade materna se mantem elevados e, o coeficiente de mortalidade materna classificado como muito alto. Apesar dos avanços para a melhoria na assistência obstétrica e a existência de políticas públicas em saúde, o número de mortes que poderiam ser evitadas com o uso de tecnologias simples no nível primário de atenção à saúde para identificação de complicações continua alarmante.

RESUMO Introdução: A medicina de família e comunidade (MFC) é a especialidade preferencial para estar presente na atenção primária à saúde (APS). O padrão ouro de formação de profissionais para a especialidade é a residência médica, momento que ao menos 70% do período de estágio é na APS. Assim, é imprescindível avaliar a qualidade de inserção da residência nesse local. Objetivo: Este estudo teve como objetivo avaliar a qualidade de implementação dos programas de residência médica em MFC na APS. Método: Utilizou-se uma ferramenta desenvolvida para a análise de implementação de residência de MFC na APS em programas pequenos (até dois residentes do segundo ano), médios (de dois a cinco) e grandes (a partir de seis), avaliando de zero a quatro pontos, entre não implantado e totalmente implantado. As notas foram obtidas a partir de entrevista com residentes, preceptores, coordenadores e gestores municipais, considerando a avaliação de quarta geração com análise de Bardin das falas. Resultado: Seis programas foram avaliados, em municípios de 20 mil a 12 milhões de habitantes, com variação de um a 22 residentes do segundo ano por programa, desde insatisfatório (um programa) a totalmente implantado (dois programas). Municípios com maior cobertura de APS apresentaram resultados de implementação melhores. As notas mais baixas foram nos itens “educação permanente” e “educação continuada”, e as mais altas na presença de especialistas em MFC como preceptores. Há diferença de percepção entre os entrevistados considerando as mesmas perguntas. O estudo sugere que municípios com maior investimento na APS também possuem melhores programas de residência, independentemente de o vínculo ser com centros educacionais ou secretarias de saúde. A pandemia de Sars-CoV-2 também dificultou a educação em saúde. Os resultados também foram definidores quando entrevistadas diferentes pessoas, demonstrando ser essencial a análise de quarta geração. Conclusão: Há a necessidade de observar a implementação dos programas de residência na APS para garantir formação de qualidade, e não apenas quantidade para provimento.

O Manual da Alimentação Cardioprotetora para Profissionais da Atenção Básica (MAC) tem objetivo de traduzir as recomendações alimentares das diretrizes sobre o tratamento e prevenção de fatores de risco cardiovascular em uma única estratégia lúdica e compreensiva. Entretanto, não se sabe como e qual o melhor método para implementá-lo na Atenção Primária em Saúde (APS). O objetivo deste artigo é apresentar o protocolo do estudo de implementação do MAC na APS de dois municípios do sudeste do Brasil. Trata-se de um estudo de implementação híbrido tipo II com desenho de ensaio clínico randomizado em cluster. Todos os serviços da APS dos municípios (n=59) serão randomizados (1:1) para o grupo que receberá uma estratégia multifacetada para implementação do MAC, que inclui não só a distribuição do material, mas uma capacitação e Auditoria e Feedback (intervenção) ou para o grupo que inclui apenas a distribuição do material, mimetizando o cenário atual (controle). O desfecho primário de implementação será avaliado a partir da taxa de orientação da Alimentação Cardioprotetora e o desfecho primário de efetividade será avaliado pelo consumo de vegetais dos usuários, em seis meses de seguimento. Os desfechos secundários são: compreensão da orientação por parte dos usuários e dos profissionais, taxa de orientações complementares ao MAC, a percepção da incorporação da orientação na prática clínica dos profissionais, a identificação de barreiras e facilitadores para a implementação do MAC e ainda peso dos usuários. Se positiva, será discutida a ampliação da capacitação para outros municípios brasileiros.

Objetivo: Conocer las perspectivas de los líderes sobre la reanudación del proceso de Acreditación Hospitalaria en el contexto de la "post-pandemia" de COVID-19. Método: estudio de caso cualitativo realizado en un gran hospital universitario de Porto Alegre (RS), Brasil. Se recogieron datos de 10 líderes estratégicos entre agosto y septiembre de 2022 mediante una entrevista semiestructurada. Se utilizó el análisis de contenido temático. Resultados: surgieron tres categorías: "Cambios y estrategias hospitalarias exigidos por la pandemia COVID-19"; "Gestión de la calidad y retos para la seguridad del paciente derivados del contexto pandémico"; y, "Gestión de la reanudación del proceso de Acreditación Hospitalaria pospandémica". Conclusión: La crisis sanitaria COVID-19 ha impuesto obstáculos a procesos previamente bien establecidos. La dirección reconoció el agotamiento de los equipos y trabajó para motivar a la gente y difundir la información necesaria para el éxito de la recertificación de la calidad.