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Introduction: The pathogenesis of post-COVID interstitial lung disease, marked by lung tissue scarring and functional decline, remains largely unknown. Objectives: We aimed to elucidate the temporal cytokine/chemokine changes in bronchoalveolar lavage (BAL) from patients with post-COVID interstitial lung disease to uncover potential immune drivers of pulmonary complications. Design: We evaluated 16 females diagnosed with post-COVID interstitial lung disease, originating from moderate to severe cases during the second epidemic wave in the Autumn of 2020, treated at the Pneumology Department of the Arad County Clinical Hospital, Romania. Their inflammatory response over time was compared to a control group. Methods: A total of 48 BAL samples were collected over three intervals (1, 3, and 6 months) and underwent cytology, gene, and protein expression analyses for pro/anti-inflammatory lung cytokines and chemokines using reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay. Results: One month after infection, there were significant increases in the levels of IL-6 and IL-8. These levels decreased gradually over the course of 6 months but were still higher than those seen in control. Interferon-gamma and tumor necrosis factor alpha exhibited similar patterns. Persistent elevations were found in IL-10, IL-13, and pro-fibrotic M2 macrophages’ chemokines (CCL13 and CCL18) for 6 months. Furthermore, pronounced neutrophilia was observed at 1 month post-COVID, highlighting persistent inflammation and lung damage. Neutrophil efferocytosis, aiding inflammation resolution and tissue repair, was evident at the 1-month time interval. A notable time-dependent reduction in CD28 was also noticed. Conclusion: Our research provides insight into the immunological processes that may lead to the fibrotic changes noted in the lungs following COVID-19.

Abstract Projections of the sea level contribution from the Greenland and Antarctic ice sheets (GrIS and AIS) rely on atmospheric and oceanic drivers obtained from climate models. The Earth System Models participating in the Coupled Model Intercomparison Project phase 6 (CMIP6) generally project greater future warming compared with the previous Coupled Model Intercomparison Project phase 5 (CMIP5) effort. Here we use four CMIP6 models and a selection of CMIP5 models to force multiple ice sheet models as part of the Ice Sheet Model Intercomparison Project for CMIP6 (ISMIP6). We find that the projected sea level contribution at 2100 from the ice sheet model ensemble under the CMIP6 scenarios falls within the CMIP5 range for the Antarctic ice sheet but is significantly increased for Greenland. Warmer atmosphere in CMIP6 models results in higher Greenland mass loss due to surface melt. For Antarctica, CMIP6 forcing is similar to CMIP5 and mass gain from increased snowfall counteracts increased loss due to ocean warming.

Background: The implementation of neonatal screening and the early initiation of lifelong therapy have helped to prevent severe complications and enabled much more favorable outcomes for early-treated phenylketonuria (ETPKU) patients. However, PKU patients tend to develop subtle cognitive and psychosocial abnormalities and the strict dietary therapy can present financial and social burden. Thus, PKU is expected to affect the quality of life (QoL) of these patients. There is insufficient evidence regarding the relationship between metabolic control and Health-Related QoL (HRQoL). We aimed to assess the effect of short- and long-term therapy on QoL among Hungarian adult PKU patients using the standardized PKU-specific PKU-QoL questionnaire.Methods: We conducted a single-centre, cross-sectional, observational study in Hungary. We included adult PKU patients treated with diet and amino acid supplements only. Patients reported HRQoL using the standardized adult PKU-QoL questionnaire and mean blood Phe concentrations were assessed for three different time periods: the previous 10 years, the previous year and concentration at the time of completing the questionnaire. The correlation between patients’ QoL scores and their Phe levels was assessed. The classical PKU group was further divided into “good” and “suboptimal” adherence groups based on individual mean Phe levels in the examined time period. We evaluated differences in QoL among the two subgroups of classical PKU patients. QoL scores between classical and non-classical patients were also compared.Results: Data from 88 adult patients were analysed (66 had classical PKU). No median PKU-QoL score reached major or severe impact/frequent symptoms in any domain. The highest scores (meaning larger burden) were mostly related to emotional impact of PKU and disease management. When performing correlation analysis between Phe levels and QoL scores by all patients we found weak to fair positive correlation in several domains either short or long term. Patients with classical PKU reported greater financial impact of PKU than patients with less severe PKU. Classical PKU patients with good therapy adherence tended to report better HRQoL scores than patients with suboptimal adherence.Conclusion: We conclude that patients showed good HRQoL using the PKU-specific questionnaire. Our study demonstrates that suboptimal metabolic control is negatively associated with patients' HRQoL.

PGD3 is the manifestation of ischemia-reperfusion injury which results from inflammation and cell death and is associated with poor outcome. This systematic-review and meta-analysis of non-randomized controlled trials on patients undergoing Ltx with reconditioned lungs via EVLP, aims to assess the association between the levels of proinflammatory biomarkers during EVLP and PGD3 development within the firsts 72 h post-Ltx. Biomarkers were categorized by timing (1-hour, T0 and 4-hours, Tend from EVLPstart) and by their biological function (adhesion molecules, chemokines, cytokines, damage-associated-molecular-patterns, growth-factors, metabolites). We employed a four-level mixed-effects model with categorical predictors for biomarker groups to identify differences between patients with PGD3 and others. The single study and individual measurements were considered random intercepts. We included 8 studies (610 measurements at T0 and 884 at Tend). The pooled effect was 0.74 (p = 0.021) at T0, and 0.90 (p = 0.0015) at Tend. The four-level model indicated a large pooled correlation between developing PGD3 at 72 h post-Ltx and inflammatory biomarkers values, r = 0.62 (p = 0.009). Chemokine group showed the strongest association with the outcome (z-value = 1.26, p = 0.042). Pooled panels of inflammation markers, particularly chemokines, measured at T0 or at Tend, are associated with the development of PGD3 within the first 72 h after Ltx.Systematic Review Registrationhttps://osf.io/gkxzh/.

Abstract Objectives: to identify elements that influence and contribute to the social vulnerability experienced by women who gave birth on the streets, according to their perceptions. Method: a qualitative study using Thematic Oral History, developed in a shelter for homeless women. The population included mothers who gave birth on the streets. The interviews were processed in three phases, as recommended by Meihy and Ribeiro: transcription, textualization, and transcreation. The data were analyzed in light of the theory of thematic analysis proposed by Braun and Clarke. Results: the following thematic axes emerged from the interviewees’ discourses: Thematic Axis 1: Drug addiction as an escape from the reality they live in; Thematic Axis 2: Immersed in violence; Thematic Axis 3: The lack of health care; Thematic Axis 4: The rupture of family ties; Thematic Axis 5: Invisibility to society. Conclusion: women who experience pregnancies in the context of the streets are immersed in conditions that generate and/or enhance social vulnerability, which permeates the specific needs of the gestation process, the obstacles inherent to living on the streets, as well as the deprivation of rights.

ABSTRACT Objectives: to verify the construct validation of an instrument for evaluating care for people living with HIV in Primary Health Care. Methods: methodological study carried out in 2021 with 260 health professionals in Recife, PE. Validation based on the internal structure was carried out at this stage using exploratory and confirmatory factor analysis, and validity based on item response theory. Results: the validation determined the retention of five factors and 63 items. The instrument’s internal consistency and quality of fit was 0.90, the Tukey-Lewis index was 0.915 and the comparative fit index was 0.918 in the confirmatory factor analysis. The indication for the absolute majority of items is adequate fit. Conclusions: the instrument has construct validity, making it possible to use it to evaluate the decentralization process and care for People Living with HIV in Primary Health Care.

Objetivo: Mapear as evidências científicas disponíveis sobre ações realizadas durante o acompanhamento dos casos de tuberculose por profissionais de saúde na Atenção Primária à Saúde. Método: Trata-se de uma revisão de escopo realizada em bases de dados nacionais e internacionais e na literatura cinzenta, segundo as recomendações do Instituto Joanna Briggs. A análise dos dados foi realizada de forma descritiva. Resultados: Foram incluídos 46 estudos que evidenciaram ações de acompanhamento dos casos de tuberculose: educação em saúde, busca ativa dos sintomáticos, tratamento diretamente observado, consulta de enfermagem e sistema de referência e contrarreferência. Os estudos elucidaram as ações que os profissionais de saúde realizam durante o acompanhamento dos casos de tuberculose na Atenção Primária à Saúde. Conclusão: Tornou-se visível o conhecimento sobre essa temática no intuito de fornecer informações que possam direcionar a atenção e prática de gestores e profissionais de saúde em relação ao acompanhamento dos casos de tuberculose.

O objetivo deste ensaio foi refletir sobre os pilares da Ciência Aberta e sua implementação no espaço Ibero-americano. A Ciência Aberta tem sido fundamental para o avanço científico moderno, promovendo colaboração e transparência na pesquisa. Este movimento se insere em um contexto de transformações nas formas de produção e circulação de informação e conhecimento. A Ciência Aberta facilita a rápida divulgação dos resultados de pesquisas, aumentando sua eficiência e impacto. A implementação da Ciência Aberta exige esforços conjuntos de financiadores, instituições e reguladores, transformando profundamente as bases da prática científica e promovendo uma ciência mais colaborativa e eficaz para enfrentar os desafios contemporâneos. No Brasil, a Ciência Aberta enfrenta desafios na comunicação científica, mas, o Brasil não está sozinho, faz parte de um movimento maior que ocorre por toda Ibero América. A implementação do acesso aberto, a internacionalização das revistas, o enfrentamento à mercantilização do conhecimento científico é central para a democratização do conhecimento. A hegemonia do inglês como língua científica impõe barreiras, mas a colaboração regional pode promover uma ciência mais inclusiva. Porém, Iniciativas como DIALNET, REDIB, LATINDEX, SciELO e Redalyc exemplificam os esforços para integrar a ciência ibero-americana às práticas de Ciência Aberta, visando o desenvolvimento sustentável e a justiça social.

The key goal in lung donation remains the improvement of graft preservation with the ultimate objective of increasing the number and quality of lung transplants (LTx). Therefore, in recent years the field of graft preservation focused on improving outcomes related to solid organ regeneration and restoration. In this contest Ex-Vivo Lung Perfusion (EVLP) plays a crucial role with the purpose to increase the donor pool availability transforming marginal and/or declined donor lungs suitable for transplantation. Aim of this proof of concept is to test the safety, suitability and feasibility of a new tilting dome for EVLP designed considering the dorsal lung areas as the “Achilles’ heel” of the EVLP due to a more fluid accumulation than in the supine standard position.

Objetivo: Elaborar um modelo lógico para avaliação da efetividade de equipes consultório na rua no controle da Tuberculose. Método: Estudo descritivo, exploratório, de corte transversal, com abordagem mista. Utilizou-se o referencial STROBE (da rede EQUATOR) para estudos observacionais em epidemiologia. Realizado em 2020, em plena pandemia da Covid-19, no período compreendido entre os meses de agosto e outubro, no âmbito da atenção primária à saúde, na cidade do Natal, Rio Grande do Norte, Brasil, com três equipes de Consultórios na Rua que atuam em dois Distritos Sanitários municipais. Resultados: Os participantes tinham uma média de idade de 36,64 anos e tempo médio de atuação profissional na equipe de consultório na rua de 2,45 anos. Constatou-se que o grau de implantação das Equipes de Consultório na Rua em Natal, Rio Grande do Norte, foi classificado como implantado (76,79%). Em relação às dimensões Estrutura e Processo, elas foram consideradas como parcialmente implantada (72,32%) e implanta (81,75%). Conclusão: A elaboração do modelo lógico-operacional permitiu uma visualização e compreensão abrangente da estrutura dessas equipes e das ações empreendidas para cuidar das pessoas em situação de rua (PSR) que enfrentam a Tuberculose. A atuação das eCnaR tem papel crucial no acesso dos PSR aos serviços de saúde, possibilitando diagnóstico precoce, tratamento, acompanhamento e recuperação dos usuários com TB. Adicionalmente, esse estudo também amplia a visibilidade das eCnaR que atendem a essa população.

The aim of this study is to analyze the level of implantation of the Tuberculosis Control Program in Primary Health Care in a medium-sized city. Normative evaluation study, with a quantitative approach, emphasizing the level of implantation of programs. The sample included 80 nurses and data collection took place from November 2017 to March 2018, using a questionnaire with 62 questions. To identify the level of implantation, the percentage of responses identified was distributed in four classifications: not implanted (from 0% to 25%); incipient (from 26% to 50%); partially implanted (from 51% to 75%) and implanted (from 76% to 100%). The Tuberculosis Control Program in the city was classified as partially implanted (62.85%). The dimensions Structure and Process were also evaluated as being in the same level (61.80% and 63.17%, respectively). The level of implantation of the program was classified as partially implanted, showing shortcomings with regard to the activities developed in the city. Health professionals are expected to make decisions to improve the program.

Objetivo: Analisar o conceito da vulnerabilidade de pessoas em situação de rua que vivem com tuberculose. Método: Trata-se de uma revisão integrativa da literatura, fundamentada no modelo de Análise de Conceito proposto por Walker e Avant. Foram utilizadas as bases de dados: LILACS, PUBMED, Web of Science e Scopus, utilizando os descritores: pessoas em situação de rua, tuberculose e vulnerabilidade nas línguas portuguesa, inglesa e espanhola. Resultados: Fizeram parte da amostra final 9 artigos, os atributos identificados para vulnerabilidade a tuberculose foram: pobreza, difícil acesso aos serviços de saúde, populações carentes, falta de moradia e desigualdades de saúde. Além disso, foi construído caso modelo, caso contrário e evidenciado os antecedentes e consequentes. Conclusão: A realização deste estudo pode contribuir para o refinamento e aprimoramento da visão dos profissionais de saúde em relação à vulnerabilidade de pessoas em situação de rua que vivem com tuberculose, e, portanto, contribuir para a prática mais humanizada e de forma integral.

Objetivo: Refletir sobre os desafios para manutenção das atividades de rotina da atenção primária à saúde além do contexto da COVID-19. Método: Estudo reflexivo a respeito dos impactos ocasionados pela pandemia da COVID-19 no funcionamento da atenção primária á saúde quanto às suas atividades de rotina. Foram utilizados documentos das bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medline e Banco de Dados em Enfermagem, buscados entre os meses de Fevereiro a Abril de 2023. Resultados: A partir das reflexões tecidas com base nos achados da literatura, observou-se que a atenção primária à saúde sofreu inflûencia do contexto pandêmico de acordo com os seus desdobramentos. Sendo assim, foram elencadas as seguintes categorias temáricas para reflexão: a atenção primária à saúde idealizada durante a pandemia da COVID-19, Dificuldades de atuação emergidas com os desdobramentos pandêmicos e Herança da pandemia que apresentam potencial fomento à remodelação da APS. Considerações finais: A atenção primária à saúde apresentou-se como importante meio de combate à covid-19. Devido a magnitude da pandemia, exigiu-se a sua reorganização, tendo muitas de suas funções colocadas em segundo plano. Assim como formas de reorganizar a atenção primária à saúde foram traçadas para controle pandêmico, novas formas de conduzi-la pós pandemia é um desafio a ser enfrentado, uma vez que tais medidas associadas ao receio de contaminação pela população levaram à não procura pelos serviços de saúde, resultando em um cenário em que doenças agudas foram negligenciadas, consequência do distanciamento entre a população e unidades de saúde.

Objetivo: Refletir sobre as ações dos profissionais enfermeiros da Atenção Primária à Saúde no enfrentamento da COVID-19 à luz da Teoria de Adaptação de Callista Roy. Método: Estudo teórico reflexivo a respeito da pandemia da COVID-19, sob a luz da teoria de adaptação de Callista Roy. Foram utilizados documentos das bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medline e Banco de Dados em Enfermagem, bem como as obras de referência da autora Callista Roy e sua teoria, buscados entre os meses de janeiro e fevereiro de 2023. Resultados: observa-se que a aplicação dos fundamentos teóricos propostos na teoria de adaptação subsidia e contribui com as práticas de enfermeiros no combate à pandemia da COVID-19. Considerações finais: Os estudos e reflexões com base na teoria de adaptação nos possibilitou vislumbrar claramente que sua associação com a prática pode fornecer um olhar integral às necessidades do indivíduo envolvendo a pessoa, ambiente, saúde e a enfermagem como forma de alcance as medidas de enfrentamento. Ademais, é notório que a compreensão desta conjuntura pelo enfermeiro e a articulação com a equipe multiprofissional, pode promover a redução dos agravos emergentes, assim como estimular melhoria nos fatores biopsicossociais da saúde da população

Objective: to compare population and care characteristics of adherence to immediate contact between mother and newborn in the first hour of life in two public maternity hospitals at usual risk. Methods: cross-sectional study with 105 mothers after normal delivery and their respective newborns in the first hour of life in two maternity hospitals with Prepartum, Labor, and Puerperium units. We used an instrument with 36 questions based on the National Guidelines of Assistance to Normal Birth. Analysis was based on the chi-square test for homogeneity and Fisher's exact test to compare the assistance provided in maternity hospitals. Results: both maternity hospitals attended the usual risk binomials. Regarding the assistance provided, only the federal maternity promoted encouragement of immediate contact between mother and newborn in the first hour of life, besides favouring 7.1% (n=3) of the binomials with the golden hour in a correct and significant way (p=0.037). Conclusion: despite the similarity of the assistance profile, only one maternity hospital performed the golden hour, being necessary the insertion of good practices in maternity hospitals. Contributions to practice: direct observation of the assistance provided to binomial identified gaps in the format and and durability of the immediate contact in maternity hospitals.

Introducción: Si bien se sabe que la muerte es parte del ciclo de vida, ante una enfermedad con muchos aspectos aún desconocidos, como lo es el COVID-19, es importante comprender cómo los trabajadores de enfermería representan este fenómeno, ya que son los únicos profesionales que continuan cuidando al individuo incluso después del final de la vida. Objetivo: analizar la estructura de las representaciones sociales sobre la muerte y el morir por COVID-19 elaboradas por profesionales de enfermería. Materiales y métodos: estudio cualitativo anclado en el aspecto estructural de la Teoría de las Representaciones Sociales con énfasis en la Teoría del Núcleo Central, desarrollado con 32 profesionales de enfermería de la ciudad de Natal, estado de Rio Grande do Norte, Brasil. La recolección de datos se realizó en línea utilizando la técnica de asociación libre de palabras. Para el análisis de los datos se utilizaron análisis prototípicos y de similitud. Resultados: el probable núcleo central de las representaciones estuvo constituido por los términos tristeza y miedo, y la composición del sistema periférico y la zona de contraste refuerzan este núcleo. Discusión: el núcleo de las representaciones de los profesionales de enfermería sobre la muerte y el morir por COVID-19 constituye un temade representación controvertido, y destaca el daño a la salud psicosocial de los trabajadores de enfermería de primera línea. Conclusiones: frente a las representaciones elaboradas sobre la muerte y el morir como consecuencia de la COVID-19, es necesario desarrollar estrategias de enfrentamiento que contribuyan a la salud psicosocial de los trabajadores de enfermería. Como citar esta artículo: da Silva, Bruno Neves; Fernandes da Silva, Valéria Gomes; Pinto, Erika Simone Galvão; Souza, Nilba Lima de; de Miranda, Francisco Arnoldo Nunes. Estrutura das representações sociais da enfermagem sobre a morte decorrente da COVID-19. Revista Cuidarte. 2023;14(1):e2588. http://dx.doi.org/10.15649/cuidarte.2588

ABSTRACT Objective: To develop and validate an instrument to evaluate the decentralization process of care for People Living with HIV in Primary Health Care. Method: Methodological study, developed in four stages: elaboration of the logical model based on the triad Structure-Process-Outcomes; development of the instrument; content validation by expert judges and technical reviewers; and semantic validation. Online questionnaires were used, and the Kappa index was used for analysis. Results: The instrument with 68 items and 8 factors was submitted to validation by expert judges who recommended the exclusion of 3 items and the alteration of 2 factors. In the validation by technical reviewers, 2 items were excluded and 6 factors were highlighted; the agreement index was ≥0.75. In the semantic validation, 87.3% of the judges answered “totally agree” for the items presented. Conclusion: The instrument is validated for its content, has 63 items and has the potential to assess the care provided for people living with HIV in Primary Health Care.

ABSTRACT Objective: To characterize the stricto sensu scientific production of Brazilian nursing that resorts to phenomenological theoretical frameworks. Method: Descriptive, exploratory, and document study carried out using the CAPES catalog of theses and dissertations from January to April 2022. Result: The sample included 600 dissertations and theses, with a predominance of the Heideggerian framework, followed by Schütz and Merleau-Ponty. Topics discussed included nursing care in women's health, mental health, pediatric and adolescent nursing, oncology nursing, obstetric nursing, Primary Health Care, as well as family and nursing education. Conclusion: Phenomenology was found to be a powerful reference for the unveiling of the phenomena of interest to the field of nursing, contributing to the construction of knowledge about the being who cares, the being who is cared for, and the care itself.