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BackgroundThe fear of clinical errors among healthcare workers (HCW) is an understudied aspect of patient safety. This study aims to describe this phenomenon among HCW and identify associated socio-demographic, professional, burnout and mental health factors.MethodsWe conducted a nationwide, online, cross-sectional study targeting HCW in France from May to June 2021. Recruitment was through social networks, professional networks, and email invitations. To assess the fear of making clinical errors, HCW were asked: “During your daily activities, how often are you afraid of making a professional error that could jeopardize patient safety?” Responses were collected on a 7-point Likert-type scale. HCW were categorized into “High Fear” for those who reported experiencing fear frequently (“once a week,” “a few times a week,” or “every day”), vs. “Low Fear” for less often. We used multivariate logistic regression to analyze associations between fear of clinical errors and various factors, including sociodemographic, professional, burnout, and mental health. Structural equation modeling was used to explore how this fear fits into a comprehensive theoretical framework.ResultsWe recruited a total of 10,325 HCW, of whom 25.9% reported “High Fear” (95% CI: 25.0–26.7%). Multivariate analysis revealed higher odds of “High Fear” among males, younger individuals, and those with less professional experience. High fear was more notable among physicians and nurses, and those working in critical care and surgery, on night shifts or with irregular schedules. Significant associations were found between “High Fear” and burnout, low professional support, major depressive disorder, and sleep disorders.ConclusionsFear of clinical errors is associated with factors that also influence patient safety, highlighting the importance of this experience. Incorporating this dimension into patient safety culture assessment could provide valuable insights and could inform ways to proactively enhance patient safety.

BackgroundThe care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. ObjectiveThis study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. MethodsWe performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. ResultsIn this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P

A prevalência de pessoas assumidamente trans e não binárias tem vindo a aumentar, sendo que no mundo hodierno estima-se representarem 0,39% e 1,19% da população mundial, respetivamente. Deste modo, torna-se cada vez mais imperativo que os cuidados de saúde primários estejam preparados para receber e orientar esta população nas suas necessidades de saúde gerais e específicas. Neste sentido, este trabalho pretende estudar o conhecimento dos profissionais de saúde e a sua abordagem aos utentes trans e não binários nas Unidades de Saúde Familiar adstritas ao Centro Hospitalar Universitário do Porto, tendo sido enviado um questionário online à população em estudo. Constatou-se que, embora exista um significativo contacto entre médicos internos e especialistas de medicina geral e familiar com pessoas trans e não binárias na prática clínica, o grau percecionado de conhecimentos e de formação acerca das necessidades específicas desta população parece ser extremamente diminuto. É, assim, fulcral o investimento na formação pré-graduada, bem como na formação pós-graduada.

Objectives Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.Methods This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen’s kappa. Two multivariable logistic regressions were built.Results According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.Conclusion At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.

BackgroundPatients with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, or major depressive disorder) have been reported to have excess mortality rates from infection compared to patients without SMI, but whether SMI is associated with higher or lower case fatality rates (CFRs) among infected patients remains unclear. The primary objective was to compare the 90-day CFR in septic shock patients with and without SMI admitted to the intensive care unit (ICU), after adjusting for social disadvantage and physical health comorbidity.Methods and findingsWe conducted a nationwide, population-based cohort study of all adult patients with septic shock admitted to the ICU in France between January 1, 2014, and December 31, 2018, using the French national hospital database. We matched (within hospitals) in a ratio of 1:up to 4 patients with and without SMI (matched-controls) for age (5 years range), sex, degree of social deprivation, and year of hospitalization. Cox regression models were conducted with adjustment for smoking, alcohol and other substance addiction, overweight or obesity, Charlson comorbidity index, presence of trauma, surgical intervention, Simplified Acute Physiology Score II score, organ failures, source of hospital admission (home, transfer from other hospital ward), and the length of time between hospital admission and ICU admission. The primary outcome was 90-day CFR. Secondary outcomes were 30- and 365-day CFRs, and clinical profiles of patients. A total of 187,587 adult patients with septic shock admitted to the ICU were identified, including 3,812 with schizophrenia, 2,258 with bipolar disorder, and 5,246 with major depressive disorder. Compared to matched controls, the 90-day CFR was significantly lower in patients with schizophrenia (1,052/3,269 = 32.2% versus 5,000/10,894 = 45.5%; adjusted hazard ratio (aHR) = 0.70, 95% confidence interval (CI) 0.65,0.75, p < 0.001), bipolar disorder (632/1,923 = 32.9% versus 2,854/6,303 = 45.3%; aHR = 0.70, 95% CI = 0.63,0.76, p < 0.001), and major depressive disorder (1,834/4,432 = 41.4% versus 6,798/14,452 = 47.1%; aHR = 0.85, 95% CI = 0.81,0.90, p < 0.001). Study limitations include inability to capture deaths occurring outside hospital, lack of data on processes of care, and problems associated with missing data and miscoding in medico-administrative databases.ConclusionsOur findings suggest that, after adjusting for social disadvantage and physical health comorbidity, there are improved septic shock outcome in patients with SMI compared to patients without. This finding may be the result of different immunological profiles and exposures to psychotropic medications, which should be further explored.

Abstract Background Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self‐report and physician assessment. Methods This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1‐week and 1‐month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100). Results A total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self‐report (80 [60–95]) and physician assessment (82 [51–94]) (p 0.05). There was a moderate correlation between patient self‐report and physician assessment (ρ = 0.596, p

O cuidar baseado nos conhecimentos científicos, do desenvolvimento de estratégias relacionais e de atitudes, bem como do desenvolvimento de um conjunto de capacidades que interagem entre si, permite ao Enfermeiro Especialista em Saúde Mental e Psiquiatria, construir relações interpessoais num ambiente afetivo estável proporcionando ao doente um cuidado diferente e peculiar. O objetivo deste estudo foi conhecer o perfil de Competência Emocional (CE) de Enfermeiros Especialistas em Saúde Mental e Psiquiatria (EESMP). A metodologia foi quantitativa tendo sido usado um questionário adaptado para esta investigação. A amostra foi do tipo bola de neve e incluiu 32 participantes, sendo maioritariamente do sexo feminino (n=26; 81,3%), com média de idades de 40 anos. Os dados foram analisados com o programa SPSS, tendo sido aplicados testes paramétricos e não paramétricos. Verificou-se que não existe relações entre as variáveis sociodemográficas e a CE. Com a variável, tempo médio diário de contacto com pessoas diagnosticadas com doença mental, obtiveram-se diferenças estatisticamente significativas na dimensão Empatia. Em relação aos determinantes da CE, confirmou-se que todas as capacidades são preditivas da mesma e que os enfermeiros especialistas apresentavam níveis moderados de CE nas suas cinco vertentes e globalmente. A dimensão “Autoconsciência”, apresentou alto nível de CE.

Objetivo: describir el perfil clínico epidemiológico del dengue en Anápolis, Goiás - BR entre los años 2016 a 2020. Métodos: estudio descriptivo de carácter cuantitativo. Se utilizaron datos de la ficha de notificación de dengue registrada en el Departamento de Vigilancia Epidemiológica. Se utilizó la prueba de chi-cuadrado con un nivel de significación del cinco (5%) (p

Objetivo: descrever o perfil clínico epidemiológico da dengue em Anápolis, Goiás - BR entre os anos 2016 a 2020. Métodos: estudo descritivo de natureza quantitativa. Foram utilizados dados da ficha de notificação de dengue cadastrada no Departamento de Vigilância Epidemiológica. Utilizado o teste qui-quadrado com nível de significância cinco (5%) (p

Objective: to describe the clinical epidemiological profile of dengue in Anápolis, Goiás - BR between the years 2016 to 2020. Methods: descriptive study of a quantitative nature. Data from the dengue notification form registered in the Epidemiological Surveillance Department were used. Chi-square test was used with significance level five (5%) (p

Abstract Background Due to their health condition, patients with neuromuscular diseases (NMD) are at greater risk of developing serious complications with COVID-19. The objective of this study was to analyze the prevalence of COVID-19 among NMD patients and the risk factors for its impact and severity during the first wave of the pandemic. Clinical data were collected from NMD-COVID-19 patients, between March 25, 2020 and May 11, 2020 in an anonymous survey carried out by expert physicians from the French Health Care Network Filnemus. Results Physicians reported 84 patients, including: 34 with myasthenia gravis, 27 with myopathy and 23 with neuropathy. COVID-19 had no effect on NMD for 48 (58%) patients and 48 (58%) patients developed low COVID-19 severity. COVID-19 caused the death of 9 (11%) NMD patients. Diabetic patients were at greater risk of dying. Patients with diabetes, hypertension or severe forms of NMD had a higher risk of developing a moderate or severe form of COVID-19. In our cohort, corticosteroids and other immunosuppressants were not significantly associated with higher COVID-19 severity for acquired NMD. Conclusion During this period, a small percentage of French NMD patients was affected by COVID-19 compared to the general French population and COVID-19 had a limited short-term effect on them. Diabetes, hypertension and a severe degree of NMD were identified as risk factors of unfavorable outcome following COVID-19. Conversely, in our cohort of patients with acquired NMD, corticosteroids or other immunosuppressants did not appear to be risk factors for more severe COVID-19.

Nuts are consumed worldwide and have valuable nutritional compositions. However, few studies exist about the consumers’ knowledge regarding nuts and similar dried fruits. This study aimed to investigate the knowledge on nuts composition (KNC) and health effects (KNHE) associated with nuts consumption and evaluate eating habits and preferences. A questionnaire survey was applied by direct interview to 300 Portuguese citizens, recruited by convenience. Anthropometric properties, behavioural and health aspects, knowledge about nuts composition and health effects, and consumption habits and preferences were evaluated and statistically analysed. Globally, the participants were not well informed on the chemical composition of nuts and about their effects on human health. Regarding age, the middle-aged adults showed a little higher level of KNC. However, no statistical differences were observed for KNC and KNHE across groups of Body Mass Index, physical exercise practice or balanced diet. Concerning eating habits and preferences, most participants (84%) like nuts, and usually consume them (58%). Among different nuts, the most consumed ones were peanuts and walnuts, followed by almonds and hazelnuts. A vast majority of participants (86%) preferred to eat the nuts in their simple form and consume them between meals. In conclusion, improvement of communication on nuts benefits to human health might be a way to increase their consumption. Our data can also help the nut industries to formulate a better strategy.

Summary: Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p

A vivência do cuidar da população reclusa, desenvolve-se num ambiente com características específicas, despertando nos enfermeiros sentimentos por vezes ambivalentes que estes necessitam ter a capacidade para gerir. Esta gestão, necessita do desenvolvimento de um conjunto de competências e recursos que dizem respeito à Competência Emocional. O objetivo geral deste estudo foi conhecer o perfil de competência emocional dos enfermeiros em contexto prisional e os objetivos específicos foram: apresentar as variáveis sociodemográficas da amostra, conhecer a relação entre variáveis sociodemográficas e profissionais e o perfil de competência emocional dos enfermeiros em contexto prisional. O estudo é do tipo quantitativo, de carácter descritivo e analítico. Teve como critérios de inclusão enfermeiros que trabalhavam no momento nos Estabelecimentos Prisionais do Porto, Santa Cruz do Bispo e Paços de Ferreira. O instrumento de recolha de dados foi um questionário que se encontra dividido em duas partes. A primeira parte era composta por questões que contemplam variáveis sociodemográficas e profissionais e a segunda parte foi composta pela “Escala Veiga de CE” (EVCE) (Veiga-Branco,1999). A amostra deste estudo foi constituída por 17 enfermeiros, na sua maioria do sexo feminino (52.9%). A grande maioria exercia funções no estabelecimento prisional do Porto (76.5%). Verificou-se existir relação entre a variável sociodemográfica estado civil e a dimensão Automotivação. Com a variável, tempo médio diário de contacto com reclusos também se obtiveram diferenças estatisticamente significativas nas dimensões Autoconsciência, Automotivação e Competência Emocional Global. A satisfação profissional também apresentou diferenças estatisticamente significativas em todas as variáveis dependentes, exceto na Automotivação e na Empatia. Em relação aos determinantes da Competência Emocional, confirmou-se que todas as dimensões são preditivas da mesma e que os enfermeiros apresentam níveis moderados de competência emocional nas suas cinco vertentes e globalmente. A dimensão “Autoconsciência”, apresentou alto nível de Competência emocional.

Objetivo: descrever o perfil clínico-epidemiológico dos pacientes com hepatite C notificada em Anápolis, Goiás no período de janeiro de 2012 a dezembro de 2018. Materiais e métodos: Trata-se de um estudo epidemiológico, observacional, descritivo e transversal de natureza quantitativa. Foram coletados dados da ficha de notificação da hepatite C (HCV) cadastradas no Departamento de Vigilância Epidemiológica da Secretaria Municipal de Saúde de Anápolis, Goiás. Foi utilizado a análise estatística pelo programa Statistical Package for Social Sciences (SPSS®) e nível de significância o valor 5% (p< 0,05) para todas as análises. Resultados: A assistência foi oferecida a 239 pacientes entre os anos estudados oscilando de 31 a 43 casos por ano. A maioria dos casos eram do sexo masculino (61,5%, p= 0,431) com faixa etária entre 30 a 50 anos (45,6%, p= 0,015) da cor parda (64%, p= 0,029) e possuíam de 5ª a 8ª série completa (20,8%, p= 0,004). O genótipo 1 foi o mais prevalente (67,5%, p= 0,644) juntamente com a forma crônica/assintomática (76,6%, p= 0,001). A fonte de infecção foi 23,0% dos casos por via sexual e 72,0% das notificações não tinha essa informação (p= 0,019). Conclusão: Neste estudo, o perfil encontrado para os portadores de HCV foi semelhante aos disponíveis na literatura. Ressalta-se a importância de conhecer a incidência do HCV para compreender sua disseminação e, assim, ter subsídios para medidas de controle no combate à infecção, além da capacitação para preenchimento adequado das fichas de notificação, já que a omissão de dados interfere diretamente no ensino e pesquisa, além da qualidade da assistência.

The regional heterogeneity of microglia was first described a century ago by Pio del Rio Hortega. Currently, new information on microglia heterogeneity throughout central nervous system (CNS) regions is being revealed by high-throughput techniques. It remains unclear whether these spatial specificities translate into different microglial behaviors in vitro. We cultured microglia isolated from the cortex and spinal cord and analyzed the effect of the CNS spatial source on behavior in vitro by applying the same experimental protocol and culture conditions. We analyzed the microglial cell numbers, function, and morphology and found a distinctive in vitro phenotype. We found that microglia were present in higher numbers in the spinal-cord-derived glial cultures, presenting different expressions of inflammatory genes and a lower phagocytosis rate under basal conditions or after activation with LPS and IFN-γ. Morphologically, the cortical microglial cells were more complex and presented longer ramifications, which were also observed in vivo in CX3CR1+/GFP transgenic reporter mice. Collectively, our data demonstrated that microglial behavior in vitro is defined according to specific spatial characteristics acquired by the tissue. Thus, our study highlights the importance of microglia as a source of CNS for in vitro studies.

Prevention of bacterial adhesion is a way to reduce and/or avoid biofilm formation, thus restraining its associated infections. The development of repellent anti-adhesive surfaces, such as superhydrophobic surfaces, can be a strategy to avoid bacterial adhesion. In this study, a polyethylene terephthalate (PET) film was modified by in situ growth of silica nanoparticles (NPs) to create a rough surface. The surface was further modified with fluorinated carbon chains to increase its hydrophobicity. The modified PET surfaces presented a pronounced superhydrophobic character, showing a water contact angle of 156° and a roughness of 104 nm (a considerable increase comparing with the 69° and 4.8 nm obtained for the untreated PET). Scanning Electron Microscopy was used to evaluate the modified surfaces morphology, further confirming its successful modification with nanoparticles. Additionally, a bacterial adhesion assay using an Escherichia coli expressing YadA, an adhesive protein from Yersinia so-called Yersinia adhesin A, was used to assess the anti-adhesive potential of the modified PET. Contrarily to what was expected, adhesion of E. coli YadA was found to increase on the modified PET surfaces, exhibiting a clear preference for the crevices. This study highlights the role of material micro topography as an important attribute when considering bacterial adhesion.

Introduction: Therapeutic plasmapheresis is a therapeutic procedure in which the patient’s blood is passed through a medical device which separates out plasma from other components of blood. The plasma is removed and replaced with a replacement solution. Studies on the use of plasmapheresis in critically ill patients are scarce. The aim of this study was to review all therapeutic plasmapheresis sessions carried out in the Hospital Beatriz Ângelo intensive care unit. Material and Methods: An observational retrospective study was conducted between April 2012 and March 2019. All patients who underwent therapeutic plasmapheresis in the intensive care unit were included, and plasmapheresis sessions held outside the intensive care unit were excluded. Results: Of 46 patients, 63% were men (n = 29), with a median age of 53 years. The most frequent diagnoses were hypertriglyceridemia-induced pancreatitis, vasculitis, autoimmune haemolytic anaemia, and atypical haemolytic-uremic syndrome. A total of 198 plasmapheresis sessions were carried out in the intensive care unit. Most of the used replacement solutions were fresh frozen plasma (34.4%), albumin/crystalloid (24.2%), and albumin/fresh frozen plasma (19.2%). The most common complications were hydroelectrolytic changes (84; 42.4%) and coagulation disorders/thrombocytopenia (65; 32.8%). There was no need to interrupt any plasmapheresis session due to complications related to the patient. Conclusion: Therapeutic plasmapheresis is a complex technique that requires specific training. The indications are diverse, and some are not consensual. Complications were frequent, but they did not increase morbidity.

IntroductionPolycystic ovarian syndrome (PCOS) is the most frequent etiology of anovulation, hyperandrogenism and infertility in women. Its pathophysiology remains poorly elucidated. Hyperprolactinemia (hPRL) is common in women of reproductive age and may partially mimic the clinical phenotype of PCOS. The simultaneous finding of both conditions is therefore not rare, however there are conflicting studies on whether a link exists between them.Materials and MethodsWe conducted a retrospective monocentric study between 2015 and 2021 and among women who were referred for possible PCOS, we selected those who met the ESHRE/Rotterdam definition criteria. hPRL was defined as two values above the upper limit of normal with at least one measurement in our centre.ResultsA total of 430 women were selected, of whom 179 met the PCOS criteria. 50 out of 179 patients (27.9%) had at least one elevated value of PRL and 21 (11.7%) had hPRL according to our definition. Among the 21 women of the PCOS/hPRL cohort, 5 (23.8%) had a microprolactinoma and all of them had PRL level ≥ 60 ng/ml. The remaining cases were macroprolactinemia (n=5), iatrogenic hPRL (n=4), primary hypothyroidism (n=1) or unexplained (n=6) despite exhaustive investigations. The metoclopramide test resulted in an increase of basal PRL < 300% in all prolactinomas and ≥ 300% in all the other etiologies.ConclusionhPRL was a common finding in PCOS women, secondary to a microprolactinoma in a quarter of cases. Metoclopramide test performed in women with hPRL below 60 ng/ml appeared as a helpful tool 1) to discriminate pituitary causes from others etiologies, 2) to potentially avoid unnecessary pituitary MRI.

Introduction: Yersinia enterocolitica infection is a zoonotic disease that varies from self-limited gastroenteritis to more severe forms. Its propensity to affect the terminal ileum and to spread to regional lymph nodes explains the potential misdiagnosis with appendicitis. Methods: We reviewed the Y. enterocoliticainfection cases in a pediatric population for the last 12 years. Results: There were 11 cases of Y. enterocolitica infection in the selected period. Four patients had a suspected surgical diagnosis: 1 intussusception, 3 acute appendicitis. Patients who presented with appendicitis-like features were older, whereas younger children most commonly presented with diarrhea and fever. Ultrasound and abdominal computed tomography (CT) were performed in appendicitis-like patients and ruled out appendicitis in 2 of the 3 cases. The only patient submitted to surgery had abnormal CT findings and an important risk factor for this infection that was not recognized at presentation. Conclusion: This condition should be considered in patients with known risk factors (such as iron overload) and with the right epidemiological setting when presenting with abdominal symptoms. The suspicion of this diagnosis in these particular cases might obviate unnecessary surgical interventions.

Nuss procedure has become the treatment of choice in pectus excavatum mainly because of the excellent functional and cosmetic results. Despite the good results, several complications have been reported. The aim of this study is to describe a case of thoracic outlet syndrome (TOS) after Nuss procedure and review the management of such rare complication. A 15-year-old boy otherwise healthy was submitted to Nuss procedure, with no perioperative complications. Two-weeks later, the patient complained of right-hand paresthesia, progressive weakness of the right arm and coldness. After imaging and electromyography, TOS diagnosis was established. Removal of the bar was proposed but refused by the patient. Conservative management with rehabilitation exercising and nerve nourishing was initiated. At 7 months, the patient recovered arm and hand function. Abrupt structural changes of thoracic cavity with marked elevation of the upper chest induce nerve and vascular compression arousing a TOS and should be acknowledged as one potential complication of Nuss procedure. Conservative management can be an alternative treatment to bar removal, showing good results on functional recovery in early stages of compression.

Este trabalho apresenta a ação desenvolvida no subprojeto do Programa Institucional de Bolsas de Iniciação à Docência (PIBID) no contexto do curso de Licenciatura em Geografia do Centro de Ensino Superior do Seridó (CERES), da Universidade Federal do Rio Grande do Norte (UFRN), no campus de Caicó (RN). Na matéria de ensino Geografia é bastante recorrente que os docentes enfrentem muitas dificuldades ao lecionar os conteúdos de Cartografia nos ensinos Fundamental e Médio, destacando-se problemas relacionados à formação e qualificação docente, a ausência ou limitação de materiais didáticos na escola e a não alfabetização cartográfica dos estudantes. Assim, o objetivo do trabalho é apresentar as experiências da oficina sobre Cartografia escolar no ensino-aprendizagem de Geografia. Essa oficina foi planejada e desenvolvida por bolsistas de iniciação à docência do PIBID-UFRN-Geografia em escolas públicas de Caicó, envolvendo estudantes matriculados do 6° ao 9° anos do Ensino Fundamental. Nela, foram produzidos materiais didáticos para o ensino-aprendizagem de conteúdos programados, sob a supervisão de professores de Geografia no ambiente escolar. Palavras-chave: Cartografia escolar, Ensino-aprendizagem de Geografia, Produção de materiais didáticos.

Introduction: Meckel’s diverticulum (MD) is usually asymptomatic but may be associated with severe complications that require awareness. This study aimed to assess the clinical and pathological features of symptomatic MD in children as well as the accuracy of [99mTc]sodium pertechnetate scintigraphy. Methods: We retrospectively reviewed all symptomatic MD in pediatric patients treated between 2007 and 2018 at a tertiary center. Records included demographics, clinical presentation, scintigraphy with [99mTc]sodium pertechnetate, surgical outcome, and histopathology. Results: There were 47 patients (93.6% males) with a median age of 4.31 [1.76-8.10] years. The most common clinical presentation was digestive bleeding (n = 25, 53.2%), followed by intestinal obstruction (n = 12, 25.5%) and diverticulitis (n = 10, 21.3%). The patients with digestive bleeding were younger than those with intestinal obstruction or diverticulitis (2.76 vs. 6.02 years). All patients with digestive bleeding underwent scintigraphy that revealed ectopic gastric mucosa in 23. From the 23 positive scintigraphy, there were 22 available histological exams, from which 21 revealed ectopic gastric mucosa; the 2 negative scintigraphy studies also revealed ectopic gastric mucosa. Therefore, scintigraphy revealed a sensitivity of 91.3% (21/23) in patients presenting digestive bleeding. In the conclusive histological exams (n = 41), ectopic mucosa was detected in 82.9% of cases: 96% in digestive bleeding, 71% in intestinal obstruction, and 60% in diverticulitis. With a median follow-up of 7.2 years, there were no mortality or major complications. Conclusion: Symptomatic MD predominated in males, the digestive bleeding occurring at younger ages. Scintigraphy demonstrated high sensitivity in the detection of ectopic gastric mucosa in patients with digestive bleeding. Overall symptomatic MD usually has ectopic mucosa. Although the surgical outcome is excellent, complications of MD should be kept in mind.

Background The measures implemented by governments worldwide to control and prevent the spread of the COVID-19 have impacted the populations and directly influenced individuals’ quality of life and consumption habits. Objective This work investigates the Portuguese population’s changes in alcohol, stimulants drinks, illegal substances, and pharmaceutical consumptions habits during the COVID-19 pandemic. Methods An online questionnaire comprising seven groups of questions–with one group referring to alcohol, stimulant drinks, illegal substances, and pharmaceuticals consumption habits–was made available to the general adult population of mainland Portugal from the 26th January through the 31st of March 2021. After applying the inclusion criteria, 1666 questionnaires were selected and analysed using descriptive and inferential statistics. Results Our results show that 48.9% of the participants have alcohol drinking habits and increased their alcohol consumption by 16% after the beginning of the COVID-19 pandemic lockdown. Furthermore, 8.7% of the respondents felt the need to increase their consumption of stimulant drinks, especially coffee, the most consumed stimulant drink (77.9%). We also observed that of the 3.1% of respondents who are usual consumers of illegal substances, 26.9% increased their consumption of these substances during the COVID-19 pandemic. Concerning pharmaceuticals, 23.2% of the respondents expressed their need to take a therapeutic drug after the start of the COVID-19 pandemic. The profile of common consumers of alcohol, stimulant drinks, illegal substances, and pharmaceuticals in the COVID-19 pandemic context is contrasting and varies according to gender, age, and employment status. Conclusions The COVID-19 pandemic led to an increase in the consumption of alcohol, stimulant drinks, illegal substances, and pharmaceuticals prescribed to treat anxiety, depression, and sleep changes in the Portuguese population. These new consumption patterns have probably aggravated domestic violence, mental diseases, and impairment of family quality of life in the Portuguese population.

ABSTRACT Purpose: to analyze information and characteristics of the language of children diagnosed with high abilities and giftedness. Methods: an integrative literature review based on a search in LILACS, MEDLINE, and Google Scholar databases, combining the keywords “Speech-Language-Hearing and high abilities”, “giftedness and child language”. Results: a total of 45 articles that met the inclusion criteria were analyzed, of which 29 were excluded and 16 selected for the review. The analysis of these articles made it possible to verify, though superficially, the aspects in the oral and written language of children with high abilities and giftedness. These children’s vocabulary and discourse are usually rich, with excellent comprehension skills. There is early interest in reading, besides noteworthy writing comprehension and decoding skills. The studies indicate that these capacities are atypical when compared with those of the population referred to as normal. The discourse of gifted children tends to be compatible with that of children two years older, and their language develops faster. Conclusion: the language of children diagnosed with high abilities and giftedness has particularities that must be better studied, as their development differs from that of other children.

A urbanização e a industrialização aceleradas é uma problemática nos dias atuais na condição térmica de cidades do semiárido brasileiro, como Caicó/RN, e que pode piorar no futuro se as temperaturas do ar aumentarem devido ao aquecimento em todo o planeta, segundo as constatações do IPCC (IPCC, 2019), proporcionando ameaças à qualidade de vida da população. Diante dessa problemática, o objetivo desta pesquisa foi analisar a influência da arborização na cidade de Caicó, através da temperatura e umidade relativa do ar, comparando duas áreas: uma com arborização densa e outra pouco arborizada. Desse modo, utilizaram-se equipamentos termohigrômetros que registraram dados horários de temperatura e umidade relativa do ar durante o período de maio a junho de 2016. A partir dessas variáveis, avaliou-se a sensação térmica nos dois pontos através dos índices de conforto térmico humano: Índices de desconforto (ID) e o Índice de temperatura e Umidade (ITU). Através dos resultados apresentados, corroboramos com Monteiro (1976) e Mendonça e Monteiro (2003) quando afirmam que a cidade gera um clima próprio (clima urbano), resultante da interferência de todos os fatores que se processam sobre a camada limite urbana e que agem no sentido de alterar o clima em escala local. Por menor que seja a cidade, é possível detectar mudanças no campo higrotérmico, como pudemos constatar em Caicó/RN.

Most UK hospitals, laboratories, and research institutions use uniform reference intervals (RI) that do not take into account known diurnal and racial variation in total white blood cells (WBC) count and its constituent parameters. These risks of excluding potentially suitable ethnic minority volunteers from participating in phase I clinical trials could call into question the validity of a trial’s findings or limit its scientific applications and ability to accurately observe drug effects upon WBC parameters. This study pools data from multiple phase I trials, assesses the effects of race and time of day on WBC count, and compares it to the existing literature to establish race and time-specific RIs. A total 13,332 venous blood samples obtained from 7,157 healthy male and female volunteers at the time of screening or admission (predosing) who took part in 35 phase I trials over a period of seven years were pooled and the data were analyzed using generalised estimating equation models. Adjusted RI of total WBC count and its individual parameters were then calculated according to time of day (morning vs. evening) for both black and nonblack populations. This study indicates that black individuals on average had lower total WBC, neutrophil, monocyte, eosinophil, and basophil counts than individuals from nonblack racial groups. Black volunteers had higher mean lymphocyte counts relative to their nonblack counterparts. These differences were deemed statistically significant. Statistically significant increases in total WBC, neutrophil, lymphocyte, and monocyte counts were also observed over the course of daily sampling. Eosinophil counts decreased during this time period, but this finding was only statistically significant in the nonblack population. Despite an observed mild diurnal increase in basophil count in both populations, this was not considered statistically significant. This high-powered study adds significant weight to the known evidence for diurnal and racial variation in WBC parameters. Importantly, it proposes specific RIs that more precisely reflect race and time of day. These could ensure increased participation of black volunteers in clinical trials for improved population representation. Furthermore, the proposed RIs allow for more accurate postdose safety monitoring and reporting, and ensure improved monitoring of postdose WBC count changes.

Abstract Background Children admitted to nutritional rehabilitation units (NRUs) for inpatient treatment of severe acute malnutrition (SAM) are at high risk of poor developmental and nutritional outcomes. The Kusamala Program is an interactive hospital-based counseling program for primary caregivers of children with SAM that integrates three modules: nutrition and feeding; water, sanitation, and hygiene (WASH); and psychosocial stimulation. This mixed methods feasibility study aimed to evaluate the implementation of the Kusamala Program in an NRU setting and developmental outcomes in children with SAM 6 months after inpatient treatment. Methods An internal pilot trial including the first 30 children and their primary caregivers enrolled to a cluster-randomized controlled trial of the Kusamala Program was performed. Barriers and enablers were identified in a qualitative study with a focus group discussion (FGD) and in-depth interviews (IDIs) with 12 hospital staff members, including five NRU nurses who deliver the Kusamala Program. Results Results demonstrated high participant engagement (100%) and adherence (87%) of primary caregivers to the Kusamala Program. Potential barriers to implementation identified through the qualitative study were caregivers’ perceived value of the program, prioritization of other ward activities, and shortages of staff. On the other hand, enablers to implementation were engaging other staff members, motivation and work ethic, and refresher training. Conclusions This mixed methods study demonstrates the feasibility of implementing the Kusamala Program in a real NRU setting. The full cluster-randomized controlled trial will be completed to evaluate the effectiveness of the Kusamala Program. Trial registration ClinicalTrials.gov, NCT03072433. Registered on 7 March 2017—retrospectively registered

The purpose of this study was to compare the external load, internal load, and technical efficacy between the first and the second matches (M1 and M2) occurring in congested fixtures (two matches in two days) using the number of sets as a moderating factor. An observational analytic research design was adopted. Data from official volleyball matches were collected during the first competitive period of the championship, comprising 14 competitive games within 10 weeks. Ten male elite volleyball athletes (age: 21.7 ± 4.19 years of age; experience: 6.2 ± 3.8 years; body mass: 85.7 ± 8.69 kg; height: 192.4 ± 6.25 cm; BMI: 23.1 ± 1.40 kg/m2) participated in this study. Players were monitored for external load (number of jumps and height of jumps) and internal load (using the rate of perceived exertion—RPE). Additionally, notational analysis collected information about attack efficacy and receptions made during matches. The mixed ANOVA revealed no significant interaction between time (M1 vs. M2) and number of sets for number of jumps per minute (p = 0.235; ηp2 = 0.114), mean jump height (p = 0.076; ηp2 = 0.193), RPE (p = 0.261; ηp2 = 0.106), attack efficacy (p = 0.346; ηp2 = 0.085), Positive reception (p = 0.980; ηp2 = 0.002) and Perfect reception (p = 0.762; ηp2 = 0.022). In conclusion, congested fixtures do not seem to affect the performance of volleyball players negatively.

Background: The COVID-19 crisis has strained world health care systems. This study aimed to develop an innovative prediction score using clinical and biological parameters (PREDICT score) to anticipate the need of intensive care of COVID-19 patients already hospitalized in standard medical units. Methods: PREDICT score was based on a training cohort and a validation cohort retrospectively recruited in 2020 in the Marseille University Hospital. Multivariate analyses were performed, including clinical, and biological parameters, comparing a baseline group composed of COVID-19 patients exclusively treated in standard medical units to COVID-19 patients that needed intensive care during their hospitalization. Results: Independent variables included in the PREDICT score were: age, Body Mass Index, Respiratory Rate, oxygen saturation, C-reactive protein, neutrophil–lymphocyte ratio and lactate dehydrogenase. The PREDICT score was able to correctly identify more than 83% of patients that needed intensive care after at least 1 day of standard medical hospitalization. Conclusions: The PREDICT score is a powerful tool for anticipating the intensive care need for COVID-19 patients already hospitalized in a standard medical unit. It shows limitations for patients who immediately need intensive care, but it draws attention to patients who have an important risk of needing intensive care after at least one day of hospitalization.

Abstract One of the most common causes of rapidly progressive glomerulonephritis (RPGN) is pauci-immune crescentic glomerulonephritis (CrGN). In the majority of cases, this condition has a positive serologic marker, the anti-neutrophil cytoplasmic antibodies (ANCAs), but in approximately 10% there are no circulating ANCAs, and this subgroup has been known as the ANCA-negative pauci-immune CrGN. RPGN can be associated with systemic diseases, but there are only few case reports describing the association with mixed connective tissue disease (MCTD). The authors report a case of ANCA-negative CrGN associated with a MCTD.

Onion (Allium cepa L.) is one of the main agricultural commodities produced and consumed around the world. In the present work, for the first time, the volatile signature of onions from different geographical regions of Madeira Island (Caniço, Santa Cruz, Ribeira Brava, and Porto Moniz) was tested with headspace solid-phase microextraction (HS-SPME/GC-qMS) and chemometric tools, showing that the volatile signature was affected by the geographical region of cultivation. Sulfur compounds, furanic compounds, and aldehydes are the most dominant chemical groups. Some of the identified volatile organic metabolites (VOMs) were detected only in onions cultivated in specific regions; 17 VOMs were only identified in onions cultivated at Caniço, eight in Porto Moniz, two in Santa Cruz, two in Ribeira Brava, while 12 VOMs are common to all samples from the four regions. Moreover, some VOMs belonging to sulfur compounds (dipropyl disulfide, 3-(acetylthio)-2-methylfuran), furanic compounds (dimethylmethoxyfuranone, ethyl furanone, acetyloxy-dimethylfuranone), and lactones (whiskey lactone isomer), could be applied as potential geographical markers of onions, providing a useful tool to authenticate onions by farming regions where the influence of latitude seems to be an important factor for yielding the chemical profile and may contribute to geographical protection of food and simultaneously benefiting both consumers and farmers.

ABSTRACT Atheroembolic renal disease (AERD) is a kidney manifestation of atherosclerosis as a systemic disease. AERD is defined as a renal impairment secondary to embolization of cholesterol crystals with consequent occlusion of renal vascularization. The current case report describes one patient with multiple risk factors but without any inciting event history who presents a very atypical clinical course of a severe and massive atheroembolic disease that developed spontaneously and silently.

Since the 1970s, international research has actively pursued hormonal male contraception (HMC) and, to a lesser extent, thermal male contraception (TMC). Although the efficacy of TMC has been confirmed in limited populations, its acceptability has not been studied in either potential users or potential prescribers.A cross-sectional descriptive multicentre study of potential male users of TMC (new fathers) and potential prescribers of TMC (new providers) was conducted between November 2016 and February 2017.The participants completed a 3-part survey, and their responses were evaluated to i) determine their socio-demographic profiles; ii) identify personal experiences with contraception; and iii) gauge the participants' knowledge, interest and preference for male contraception, particularly TMC. For new providers only, the survey included a fourth part to evaluate professional experience with male contraception.The participation rate was 51% for new fathers (305 NFs) and 34% for new providers (300 NPs, including 97 men (male new providers, MNPs) and 203 women (female new providers, FNPs)). Only 3% of NFs and 15% of NPs knew about TMC (including 26% of the MNPs and 10% of the FNPs, p

Within the paradigm of the experience economy, the literature has recently focused on the importance of creating the conditions to provide individuals with positive, meaningful and memorable consumption experiences. The consumption experience model proposed by Pine and Gilmore, which is based on four dimensions – entertainment, aesthetics, education and escapism – has been operationalized and adapted in several settings. This study presents the results obtained from the analysis of participants’ experiences at the Querença Market, from the perspective of visitors. This initiative is part of a pilot project for territorial intervention – the Querença Project - which was implemented by nine young graduates in the region of Algarve, Portugal. Through a diversified offering of products and cultural and nature-related activities, based on the co-creation process with the local community, it was possible to revitalize the traditional village market, which became extinct 70 years ago. The results of the questionnaires presented to visitors of the market highlighted the multi-sensory nature of the event, which is related to the wide diversity of sensory stimuli associated with food, agricultural products and human interaction. Visitors described an overall positive and memorable experience, emphasizing the dimensions related to “aesthetics” and “entertainment.”

INTRODUCTION:Rupatadine is a marketed second generation antihistamine, with anti-PAF activity, indicated for symptomatic treatment of allergic rhinitis and urticaria. This study was conducted to evaluate the pharmacokinetics (PK), pharmacodynamics (PD), safety and tolerability of rupatadine in healthy Japanese subjects after single and multiple oral doses. METHODS:In this randomised, double-blind, placebo-controlled study, 27 male and female healthy Japanese subjects were administered single and multiple escalating rupatadine dose of 10, 20 and 40 mg or placebo. Blood samples were collected at different time points for PK measurements and subjects were assessed for safety and tolerability. The effect of rupatadine on cognitive functioning was evaluated by means of computerized cognitive tests: rapid visual information processing (RVP), reaction time (RT), spatial working memory (SWM) and visual analogue scales (VAS). RESULTS:Exposure to rupatadine as measured by Cmax and AUC was found to increase in a dose dependent manner over the dose range of 10-40 mg for both single and multiple dose administration. The safety assessments showed that all treatment related side effects were of mild intensity and there were no serious adverse events (SAEs) or withdrawals due to treatment-emergent adverse events (TEAEs) in this study. The therapeutic dose of rupatadine did not show any CNS impairment in any of the cognitive tests. CONCLUSIONS:This study demonstrated that rupatadine is safe and well tolerated by Japanese healthy subjects. The PK-PD profile confirmed previous experience with rupatadine.

This study was developed to evaluate the repellent activity of N,N-diethyl-3-methylbenzamide (DEET) against Amblyomma cajennense nymphs. Two repellent bioassays were compared and the effective concentration and repellent time were calculated. The fingertip test was accomplished to evaluate in vivo four concentrations of the compound (0.200; 0.100; 0.050 and 0.025 mg.cm-2) and the filter-paper bioassay to evaluate in vitro the two highest concentrations. The compound provided repellence higher than 90% in all concentrations and at least 95% repellency in the highest concentration over 5 hours. The effective concentration against 50% of tested nymphs (EC50) was 0.006 mg.cm-2 and the EC99 was 0.036 mg.cm-2. Those concentrations were lower than the ones obtained against other tick species, denoting the effectiveness of DEET against A. cajennense. The repellency time against 50% of the ticks (RT50) was 4.8 hours and the RT90 was 2.7 hours. Both bioassays were adequate to evaluate A. cajennense repellency and provided similar results; however the in vivo test is more appropriate to estimate the effective concentration and repellency time.Este estudo foi conduzido com o objetivo de avaliar a atividade repelente do N,N-diethyl-3-methylbenzamide (DEET) sobre ninfas de Amblyomma cajennense. Dois bioensaios para a avaliação de repelência foram comparados e cálculos da concentração eficaz e do tempo de repelência foram realizados. Foram empregados o bioensaio da ponta do dedo, para avaliação in vivo de quatro concentações do químico (0,200; 0,100; 0,050 e 0,025 mg.cm-2) e o bioensaio do papel filtro, para a avaliação in vitro das duas concentrações mais altas. O composto conferiu mais de 90% de repelência em todas as concentrações utilizadas e 95% de repelência por mais de cinco horas na maior concentração. A concentração do composto efetiva contra 50% das ninfas testadas (CE50) foi de 0,006 mg.cm-2 e a CE99 foi de 0,036 mg.cm-2. Estas concentrações são mais baixas do que as observadas em outras espécies de carrapatos, denotando a efetividade do princípio contra A. cajennense. O tempo de repelência de 50% dos carrapatos (TR50) foi de 4,8 horas e o TR90 de 2,7 horas. Os dois bioensaios avaliados permitiram a observação de percentuais de repelência igualmente altos e se mostraram adequados para tal avaliação, sendo que o teste in vivo é mais indicado para cálculo da concentração eficaz e da duração da repelência.

The thermostable enzyme systems produced by the thermophilic ascomycete fungus Talaromyces emersonii cultivated on various carbon sources were investigated for the production of high value products from sugar beet. A broad range of enzymatic activities relevant to cellulose, hemicellulose, and pectin hydrolysis were identified in T. emersonii culture filtrates. In hydrolysis experiments conducted at 71ºC, the enzyme cocktails generated sugar-rich syrups from untreated sugar beet plants. Maximal levels of sugar beet hydrolysis were obtained with T. emersonii enzyme cocktails induced with sorghum/ beet pulp (68%) and sugar beet plant (56%). The principle monosaccharides released were glucose, xylose, and arabinose with minor amounts of galactose and galacturonic acid. Northern analysis of RNA isolated from T. emersonii when sugar beet plants were used as the sole carbon inducing source showed that genes required for polysaccharide hydrolysis and five carbon monosaccharide metabolism were co-ordinately expressed.

This study aimed to identify 2,6-dichlorophenol (2,6-DCP) in Amblyomma cajennense and to evaluate its role in A. cajennense and Rhipicephalus sanguineus courtship. Hexanic extract from attractive females was purified by solid phase extraction and the phenol was identified by the single ion monitoring method using GC/MS. In an olfactometer, the responses of A. cajennense and R. sanguineus males to females, control rubber septa or rubber septa impregnated with 2,6-DCP at 50, 500, and 5000 ng, respectively, were studied. 2,6-DCP was identified in A. cajennense extract and the males oriented themselves toward the concentration of 500 ng. These septa and the females were recognized as copula partners. The septa treated with 2,6-DCP did not attract and were not even recognized by the R. sanguineus males, whereas the females were recognized. Due to the presence of 2,6-DCP in A. cajennense and the results of biological bioassays, it was concluded that this compound acts as an attractant and mounting sex pheromone in this tick, but it does not play any role in R. sanguineus courtship.

The environmental concern about waste generation and the gradual decrease of oil reserves has led the way to finding new waste materials that may partially replace the bitumens used in the road paving industry. Used motor oil from vehicles is a waste product that could answer that demand, but it can also drastically reduce the viscosity, increasing the asphalt mixture’s rutting potential. Therefore, polymer modification should be used in order to avoid compromising the required performance of asphalt mixtures when higher amounts of waste motor oil are used. Thus, this study was aimed at assessing the performance of an asphalt binder/mixture obtained by replacing part of a paving grade bitumen (35/50) with 10% waste motor oil and 5% styrene-butadiene-styrene (SBS) as an elastomer modifier. A comparison was also made with the results of a previous study using a blend of bio-oil from fast pyrolysis and ground tire rubber modifier as a partial substitute for usual PG64-22 bitumen. The asphalt binders were tested by means of Fourier infrared spectra and dynamic shear rheology, namely by assessing their continuous high-performance grade. Later, the water sensitivity, fatigue cracking resistance, dynamic modulus and rut resistance performance of the resulting asphalt mixtures was evaluated. It was concluded that the new binder studied in this work improves the asphalt mixture’s performance, making it an excellent solution for paving works.

Considering the existing gap in the Brazilian context of researches in the area of specific purpose course planning based on text genres (RAMOS, 2004) and trying to contribute to its development, we present the text genres and themes evaluated as necessary to act in professional and academic contexts of the Biotechnology area. To map these necessities, we applied a questionnaire to students and teachers, in a federal institution, and analyzed the results based on the sociodiscoursive interactionism principles, theory which has Bronckart, Schneuwly and Dolz (MACHADO, 2005) as precursors.

This paper measures the extent to which medical groups experience external pay-for-performance incentives based on quality and patient satisfaction and the extent to which these groups pay their primary care and specialist physicians using similar criteria. Over half (52%) of large medical groups received bonus payments from health insurance plans in the period 2006–2007 based on measures of quality and patient satisfaction. Medical groups facing external pay-for-performance incentives are more likely to pay their primary care physicians (odds ratio [OR] 4.5; p