A pessoa com dor crónica : um modelo de acompanhamento de enfermagem

RESUMO A dor crónica reflete-se na vida das pessoas e altera os padrões de vida diária e a perceção do estado de saúde. A disposição para gerir novas situações, desafios e a aquisição ou desenvolvimento de estratégias para reencontrar o equilíbrio constituem elementos fundamentais para o controlo da dor. Esta realidade constituiu o fulcro para o desenvolvimento desta investigação conduzida a partir da questão: Qual o modelo de cuidados de enfermagem que melhor resposta poderá dar às necessidades da pessoa com dor crónica, promovendo a articulação e a continuidade dos cuidados? A investigação tomou por objeto de estudo a dor crónica, tendo por finalidade a definição de um modelo de intervenção de enfermagem, sustentado no processo de transição, que se integre na organização de cuidados para acompanhamento da pessoa com dor crónica. Adotando um paradigma construtivista, foi desenhada uma abordagem fundada em duas fases distintas: a primeira fase teve como objetivo caracterizar o processo de viver com dor crónica e o modelo de cuidados em uso nas organizações no acompanhamento das pessoas com dor crónica; a segunda fase visou o desenvolvimento de um modelo de acompanhamento de enfermagem à pessoa com dor crónica, que assegure uma resposta às necessidades da pessoa/família, promovendo a articulação e a continuidade de cuidados entre os diferentes contextos de cuidados de saúde, com vista à melhoria do nível de satisfação da pessoa com o controlo da dor e melhoria da qualidade de vida da pessoa com dor crónica. A recolha de dados decorreu entre agosto de 2008 e maio de 2013. Participaram no estudo pessoas com dor crónica utilizadoras de cuidados de saúde de uma unidade local de saúde e profissionais da saúde da região norte do país, uns como informantes-chave sobre a organização dos cuidados às pessoas com dor crónica, outros como participantes num grupo de discussão organizado com o objetivo de contribuir para o desenvolvimento dos princípios orientadores de um modelo de acompanhamento de enfermagem das pessoas com dor crónica. Na primeira fase do estudo foram utilizados os seguintes instrumentos: o Questionário sociodemográfico e clínico; o BPI(pt); a EAEDC(pt); o CADR( pt) e o SF36v2(pt) na abordagem das pessoas com dor crónica. Recorremos também à entrevista semiestruturada na abordagem às pessoas com dor crónica e aos informanteschave. Na segunda fase foi utilizada a estratégia de grupo de discussão, formado por peritos na área do acompanhamento das pessoas com dor crónica, no sentido de gerar informação útil para a conceção do modelo. Dos resultados destaca-se a identificação de grupos de pessoas que vivem com dor crónica com maior vulnerabilidade, associada à perceção da severidade e interferência da dor no seu quotidiano, nomeadamente: as mulheres, os mais idosos e as pessoas com baixa escolaridade. O viver com dor crónica é influenciado pelas crenças, significados e atitudes face à dor. Também variáveis contextuais como o estatuto socioeconómico, o suporte familiar, os recursos da comunidade, interferem na vivência desta transição. Apesar dos esforços enveredados, a dor é um fenómeno subdiagnosticado na conceção dos cuidados de enfermagem e condicionado pela existência de uma informação insuficiente sobre a dor, e, ainda, por uma deficiente organização dos cuidados. A proposta do modelo de cuidados de enfermagem no acompanhamento da pessoa com dor crónica assenta em três elementos estruturantes: as políticas de saúde, a organização de cuidados de enfermagem e o processo de cuidados. Os pressupostos subjacentes à política de saúde encontram-se adequados, suportam o desenvolvimento do modelo proposto, orientados pelo PNS, assim como pelo PNCDor. Contudo, a operacionalização destas orientações no contexto da prática clínica nem sempre responde às necessidades efetivas da pessoa com dor crónica. O modelo proposto pressupõe a centralidade no cliente e família. O recurso a uma equipa multiprofissional para fazer face à dor crónica é muitas vezes imprescindível. A definição de circuitos e fluxos de referenciação, incluindo o processo de sinalização para equipas especializadas no controlo da dor como uma estratégia relevante para a organização dos cuidados, enfatizando o recurso aos cuidados de saúde primários. O processo de conceção de cuidados de enfermagem deverá ter em atenção que as transições estão associadas a mudanças que ocorrem ou podem ocorrer na pessoa, resultantes deste processo de viver com dor: mudanças na condição de saúde e na forma como estas se instalam e geram transformações na própria pessoa e nas circunstâncias que a rodeiam. Por isso, é necessário que o modelo de cuidados de enfermagem no acompanhamento da pessoa com dor crónica esteja orientado para dar resposta aos aspetos vivenciados na transição, garantindo por essa via a continuidade e avaliação dos cuidados

Easiness, usefulness and intention to use a MOOC in nursing

Background: The growing ageing population and the increasing prevalence of non-communicable diseases call for innovation and healthcare mastered professional skills. Emerging digital learning contents envisioning to complement education, lifelong learning and in-service training. The use of digital platforms allows nurses to access contents in several formats, enabling the required pedagogical autonomy and personal time management. This allows nurses to enrol in education wherever accessible, reducing personal and professional costs and ensuring high-quality standards. Objectives: To assess students and nurses’ easiness, usefulness and intention to use a Massive Open Online Course (MOOC) as an educational resource to enhance self-management intervention skills in COPD patients. Methods: An exploratory, descriptive and transversal study was conducted. Participants were nursing students, registered nurses and rehabilitation nurses. A questionnaire supported by Davis Technology Acceptance Model and on the determinants of the ease-of-use perception of Venkatesh was applied. An EFA was performed and two dimensions were obtained (perceived easiness and global quality of the course and perceived usefulness and intention to use the MOOC) and groups were compared in these dimensions. Results: From the total participants (n = 93), 65.6% were nursing students, 15.1% were Portuguese nurses and 19.4% were Portuguese rehabilitation nurses. The perceived easiness and global quality score of the course were 4.70 (SD = 0.314) and the perceived usefulness and intention to use the MOOC was 4.73 (SD = 0.346). Rehabilitation nurses, who are older, scored higher than nurses and students (χ2(2, n = 93) = 8.43, p = .015, ε2 = 0.092). The dropout rate was 25%. Conclusions: The MOOC showed usefulness and nurses’ intention to use this educational resource in future education and yielded high average rates of perceived easiness and global quality. These massive courses unlock new opportunities for nursing education and to lifelong learning in nursing, enhancing safety and quality of the healthcare services in supporting patients to achieve a better quality of life.info:eu-repo/semantics/publishedVersio

Genome-wide identification, phylogeny, and gene duplication of the epigenetic regulators in Fagaceae

Epigenetic regulators are proteins involved in controlling gene expression. Informationabout the epigenetic regulators within the Fagaceae, a relevant family of trees andshrubs of the northern hemisphere ecosystems, is scarce. With the intent to character-ize these proteins in Fagaceae, we searched for orthologs of DNA methyltransferases(DNMTs) and demethylases (DDMEs) and Histone modifiers involved in acetylation(HATs), deacetylation (HDACs), methylation (HMTs), and demethylation (HDMTs) inFagus,Quercus,andCastaneagenera. Blast searches were performed in the availablegenomes, and freely available RNA-seq data were used to de novo assemble transcrip-tomes. We identified homologs of seven DNMTs, three DDMEs, six HATs, 11 HDACs,32 HMTs, and 21 HDMTs proteins. Protein analysis showed that most of them havethe putative characteristic domains found in these protein families, which suggeststheir conserved function. Additionally, to elucidate the evolutionary history of thesegenes within Fagaceae, paralogs were identified, and phylogenetic analyses were per-formed with DNA and histone modifiers. We detected duplication events in all speciesanalyzed with higher frequency inQuercusandCastaneaand discuss the evidence oftransposable elements adjacent to paralogs and their involvement in gene duplication.The knowledge gathered from this work is a steppingstone to upcoming studies con-cerning epigenetic regulation in this economically important family of Fagaceaeinfo:eu-repo/semantics/publishedVersio

Analysis of malaria associated genetic traits in Cabo Verde, a melting pot of European and sub Saharan settlers

Malaria has occurred in the Cabo Verde archipelago with epidemic characteristics since its colonization. Nowadays, it occurs in Santiago Island alone and though prophylaxis is not recommended by the World Health Organization, studies have highlight the prospect of malaria becoming a serious public health problem as a result of the presence of antimalarial drug resistance associated with mutations in the parasite populations and underscore the need for tighter surveillance. Despite the presumptive weak immune status of the population, severe symptoms of malaria are not observed and many people present a subclinical course of the disease. No data on the prevalence of sicklecell trait and red cell glucose-6-phosphate dehydrogenase deficiency (two classical genetic factors associated with resistance to severe malaria) were available for the Cabo Verde archipelago and, therefore, we studied the low morbidity from malaria in relation to the particular genetic characteristics of the human host population. We also included the analysis of the pyruvate kinase deficiency associated gene, reported as putatively associated with resistance to the disease. Allelic frequencies of the polymorphisms examined are closer to European than to African populations and no malaria selection signatures were found. No association was found between the analyzed human factors and infection but one result is of high interest: a linkage disequilibrium test revealed an association of distant loci in the PKLR gene and adjacent regions, only in non-infected individuals. This could mean a more conserved gene region selected in association to protection against the infection and/or the disease

The dynamics of flower development in Castanea sativa Mill

The sweet chestnut tree (Castanea sativa Mill.) is one of the most significant Mediterranean tree species, being an important natural resource for the wood and fruit industries. It is a monoecious species, presenting unisexual male catkins and bisexual catkins, with the latter having distinct male and female flowers. Despite the importance of the sweet chestnut tree, little is known regarding the molecular mechanisms involved in the determination of sexual organ identity. Thus, the study of how the different flowers of C. sativa develop is fundamental to understand the reproductive success of this species and the impact of flower phenology on its productivity. In this study, a C. sativa de novo transcriptome was assembled and the homologous genes to those of the ABCDE model for floral organ identity were identified. Expression analysis showed that the C. sativa B- and C-class genes are differentially expressed in the male flowers and female flowers. Yeast two-hybrid analysis also suggested that changes in the canonical ABCDE protein–protein interactions may underlie the mechanisms necessary to the development of separate male and female flowers, as reported for the monoecious Fagaceae Quercus suber. The results here depicted constitute a step towards the understanding of the molecular mechanisms involved in unisexual flower development in C. sativa, also suggesting that the ABCDE model for flower organ identity may be molecularly conserved in the predominantly monoecious Fagaceae family.This work was funded by FCT/COMPETE/FEDER with the project grant POCI-01-0145- FEDER-027980/PTDC/ASP-SIL/27980/2017—“FlowerCAST—Characterisation of genetic and environmental determinants involved in reproductive development of Castanea sativa”. A.T.A. and S.A. were supported by FCT with PhD grants (ref. SFRH/BD/136834/2018 and SFRH/BD/146660/2019, respectively)

A Cross-Sectional Survey-Based Study of Medical Oncologists

Funding Information: We would like to thank Andrea Bothwell who wrote the manuscript outline and first draft on behalf of Springer Healthcare Communications. We also thank Prof. Carina Silva (ESTEsL – Escola Superior de Tecnologias de Saúde de Lisboa) who performed the preliminary statistical analysis of this study. This medical writing assistance and statistical analysis was funded by CUF Oncologia. Funding Information: Diogo Alpuim Costa has received honoraria from the Portuguese Navy, CUF Oncologia, and NTT DATA, and has served as a speaker, advisory board member, or has received research or education funding from CUF Oncologia, AstraZeneca, Hoffmann-La Roche, Merck KGaA, Novartis, Pfizer, Uriage, Daiichi Sankyo, Gilead, Merck Sharp & Dohme, Nanobiotix, Puma Biotechnology Inc., Sanofi, and Seagen Inc. Margarida Brito has participated as advisory board member for Roche, Novartis, Merck Sharp & Dohme, and Pfizer. Mário Fontes-Sousa has served as a speaker or advisory board member for Bristol Myers Squibb, Daiichi Sankyo, Gilead, Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Roche, and Servier. Diogo Martins-Branco received honoraria and advisory board fees from Janssen, Pfizer, Merck Sharp & Dohme, Angelini, AstraZeneca, and Novartis, meeting and travel grants from LEO Farmacêuticos, Merck Sharp & Dohme, Ipsen, Janssen, and Roche, and institutional grants from F. Hoffmann-La Roche Ltd. José Guilherme Gonçalves Nobre, João Paulo Fernandes, Marta Vaz Batista, Ana Simas, Carolina Sales, Helena Gouveia, Leonor Abreu Ribeiro, Andreia Coelho, Mariana Inácio, André Cruz, Mónica Mariano, Joana Savva-Bordalo, Ricardo Fernandes, André Oliveira, Andreia Chaves, Mafalda Sampaio-Alves, and Noémia Afonso have nothing to declare. Publisher Copyright: © 2022, The Author(s).Introduction: Cancer care providers have faced many challenges in delivering safe care for patients during the COVID-19 pandemic. This cross-sectional survey-based study investigated the impact of the pandemic on clinical practices of Portuguese medical oncologists caring for patients with breast cancer. Methods: An anonymous online survey comprising 42 questions gathered information regarding COVID-19 testing, treatment in (neo)adjuvant and metastatic settings, and other aspects of breast cancer management. Practices before and during the pandemic were compared, and potential differences in outcomes according to respondents’ regions, case volumes, and practice type were explored. Results: Of 129 respondents, 108 worked in the public health system, giving a representative national picture of the impact of the COVID-19 pandemic on breast cancer management. Seventy-one percent of respondents reported a reduction in visits for new cases of breast cancer, and there was a shift towards increased use of telemedicine. Clinical decision-making was largely unaffected in the most aggressive indications (i.e., triple-negative, HER2-positive, visceral crisis). The use of neoadjuvant therapy increased when access to surgery was difficult, whereas dose-dense regimens decreased, and cyclin-dependent kinase 4/6 inhibitor treatment decreased for less aggressive disease and increased for more aggressive disease. The use of oral formulations and metronomic chemotherapy regimens increased, and clinical trial participation decreased. Some differences by respondents’ region and case volume were noted. Conclusion: Medical oncologists in Portugal implemented many changes during the COVID-19 pandemic, most of which were logical and reasonable responses to the current healthcare emergency; however, the true impact on patient outcomes remains unknown.publishersversionepub_ahead_of_prin

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

Searching for SARS-CoV-2 in Cancer Tissues: Results of an Extensive Methodologic Approach based on ACE2 and Furin Expression

SARS-CoV-2 pandemics have been massively characterized on a global scale by the rapid generation of in-depth genomic information. The main entry gate of SARS-CoV-2 in human cells is the angiotensin-converting enzyme 2 (ACE2) receptor. The expression of this protein has been reported in several human tissues, suggesting a correlation between SARS-CoV-2 organotropism and ACE2 distribution. In this study, we selected (a series of) 90 patients who were submitted to surgery for tumor removal between the beginning of the SARS-CoV-2 pandemic and the closure of operating rooms (by the end of March 2020) in two different countries—Portugal and Brazil. We evaluated the expressions of ACE2 and furin (another important factor for virus internalization) in colon (n = 60), gastric (n = 19), and thyroid (n = 11) carcinomas. In a subseries of cases with PCR results for SARS-CoV-2 detection in the peri-operatory window (n = 18), we performed different methodological approaches for viral detections in patient tumor samples. Our results show that colon and gastric carcinomas display favorable microenvironments to SARS-CoV-2 tropism, presenting high expression levels of ACE2 and furin. From the subseries of 18 cases, 11 tested positive via PCR detection performed in tumor blocks; however, a direct association between the ACE2 expression and SARS-CoV-2 infection was not demonstrated in cancer cells using histology-based techniques, such as immunohistochemistry or in situ hybridization. This study raises the possibility of ACE2-mediated viral tropism in cancer tissues to be clarified in future studies