Mortality in Pediatric Palliative Care in a Tertiary Center

Introduction: Complex chronic diseases have been responsible for about a third of all pediatric deaths in Portugal in recent years. Early referral and implantation of an advance care plan are strategies that result in greater preparation on the part of families for dealing with the course of illness of these children. This study aimed to characterize the mortality data of patients followed by the pediatric palliative care in-hospital support team in a tertiary center between January 2018 and June 2021. Methods: This retrospective study was performed using the analysis of clinical files, demographic data, nosological groups, referral dates, expectations, and place of death of patients as well as the interventions carried out by the team. Results: In total, 64 children were followed by the pediatric palliative care in-hospital support team, 25 (39%) of whom died. More than half of the children who died had neurological pathology, which was the most frequent diagnostic area. Moreover, 14 (56%) children died less than 6 months after their referral to the team. Most of the children died during hospitalization (56%), while 28% of the deaths occurred at home. Conclusion: The collected data suggests a late referral to pediatric palliative care, which is why it is of utmost importance to invest in the creation of specialized teams at the national level and the training of health professionals in this area. The main place of death was the hospital, as in previous studies, although with an apparent increasing trend of deaths at home

Paleoenvironmental evolution of estuarine systems during the last 14000 years - the case of Douro Estuary (NW Portugal)

Proceedings of the 8th International Coastal Symposium, ICS 2004, Itajaí/Itapema, Santa Catarina, Brazil, 14 to 19 March 200

Marine terrace development on reefless volcanic islands:New insights from high-resolution marine geophysical data offshore Santa Maria Island (Azores Archipelago)

Submerged marine terraces are relict coastal erosional landforms now underwater due to rising sea level and/or land subsidence. Using as case study the shelf around Santa Maria Island (North Atlantic Ocean), we intend to advance our knowledge on the formation and preservation of these features on reefless volcanic islands. Santa Maria is an ideal place to study their combined generation, since it displays a sequence of subaerial and submerged marine terraces (the latter not studied before), distributed between 7/230 m in elevation, and 1240/ 12140 m in depth, respectively. Based on some geological constraints, we investigated a possible correlation between the formation of the different terraces with known sea-level changes. Our results suggest that the spatial distribution of marine terraces at Santa Maria depends on the complex interplay between glacio-eustatic sea-level fluctuations, the island's vertical motion trends, the morphology of the shelf, and the intensity of marine erosion. Subaerial terraces probably developed from ~3.5 Ma to ~1 Ma following a fortuitous conjugation of optimal exposure to energetic waves and a suitable arrangement/lithology of the stratigraphic units promoting easier erosion. Their preservation was likely promoted by the uplift trend the island experienced in the last 3.5 Ma, which was rapid enough to prevent their destruction by subsequent highstands. The submerged terraces, presumably all younger than ~1 Ma, were largely influenced by shelf gradient, leading to more developed and preserved terraces in wider and low-gradient sectors. Displacement by active faults also conditioned the formation and further development of both subaerial and submerged terraces, with tectonic activity documented for the 0.693 Ma\u20132.7 Ma period

Impulsivity across reactive, proactive and cognitive domains in Parkinson's disease on dopaminergic medication: Evidence for multiple domain impairment.

Impulse control disorders (ICD) may occur in Parkinson's disease (PD) although it remains to be understood if such deficits may occur even in the absence of a formal ICD diagnosis. Moreover, studies addressing simultaneously distinct neurobehavioral domains, such as cognitive, proactive and reactive motor impulsivity, are still lacking. Here, we aimed to investigate if reactive, proactive and cognitive impulsivity involving risk taking are concomitantly affected in medicated PD patients, and whether deficits were dependent on response strategies, such as speed accuracy tradeoffs, or the proportion of omission vs. commission errors. We assessed three different impulsivity domains in a sample of 21 PD patients and 13 matched controls. We found impaired impulsivity in both reactive (p = 0.042) and cognitive domains (p = 0.015) for the PD patients, irrespective of response strategy. For the latter, effect sizes were larger for the actions related with reward processing (p = 0.017, dCohen = 0.9). In the proactive impulsivity task, PD patients showed significantly increased number of omissions (p = 0.041), a response strategy which was associated with preserved number of commission errors. Moreover, the number of premature and proactive response errors were correlated with disease stage. Our findings suggest that PD ON medication is characterized compared to healthy controls by impairment across several impulsivity domains, which is moderated in the proactive domain by the response strategy