A Alexitimia e a Desregulação Emocional como Correlatos da Agressividade na Idade Avançada: estudo numa amostra de idosos

Objetivos: explorar os níveis de agressividade autopercecionados numa população idosa institucionalizada, comparando-os com um grupo de idosos da comunidade; estudar os correlatos sociodemográficos e clínicos da agressividade e as correlações entre a agressividade e a desregulação emocional e a alexitimia. Método: A amostra foi constituída por 326 idosos, sendo 209 da comunidade e com 117 Institucionalizados, com uma média de idades de 75,12 anos (DP = 8,79). Todos os participantes foram avaliados com uma bateria de testes que incluía o Aggression Questionnaire, a Toronto Alexythimia Scale – 20 itens e a Difficulties in Emotion Regulation Scale. Resultados: Não foram encontradas diferenças a nível de agressividade entre idosos institucionalizados e da comunidade, foram sim encontrados maiores níveis de alexitimia no grupo de idosos institucionalizados, assim como níveis mais elevados de desregulação emocional. O nível da agressividade autopercecionada em idosos institucionalizados, correlacionou-se com a alexitimia e a desregulação emocional. Conclusão: A alexitimia e a desregulação emocional correlacionam-se com a agressividade autopecercionada na idade avançada. A alexitimia e a desregulação emocional correlacionam-se com a agressividade auto-percebida em pessoas idosas institucionalizadas. Esta descoberta é importante para orientar as escolhas terapêuticas nestes contextos. / Objectives: To explore the levels of self-perceived aggressiveness in institutionalized elderly, comparing them to a group of elderly people in the community; to study the socio- demographic and clinical correlates of aggressiveness and the correlations between aggressiveness and emotional dysregulation and alexithymia. Method: The sample consisted of 326 elderly, 209 from the community and 117 institutionalized, with an average age of 75.12 years (SD = 8.79). All participants were assessed with a battery of tests, which included the Aggression Questionnaire, the Toronto Alexithymia Scale - 20 items, and the Difficulties in Emotion Regulation Scale. Results: No differences were found in aggressiveness between institutionalized and community elderly, but higher levels of alexitimia were found in the institutionalized elderly group, as well as higher levels of emotional dysregulation. The level of self- perceived aggressiveness in institutionalized elderly correlated with alexitimia and emotional dysregulation. Conclusion: Alexithymia and emotional dysregulation correlate with self-perceived aggressiveness in older institutionalized people. This finding is important to guide therapy choices in these settings

O outcome da utilização do dispositivo mecânico de compressão torácica LUCAS® durante a paragem cardiorrespiratória: uma revisão integrativa da literatura

Introduction: Heart arrest is a critical event that prompts the stopping of spontaneous blood flow. To restore it and secure the maintenance of vital organs, chest compression can be operated either manually or by the means of a mechanical device. Goals: Analysing the existing scientific evidence on the effectiveness of the LUCAS® mechanical chest compression device in the event of heart arrest. Materials and methods: An integrative literature review using the PubMed, Medline, Cinahl and Cochrane digital databases with the query: cardiopulmonary resuscitation AND mechanical chest compression AND LUCAS®, with search results going from 2016, the year of the launching of the LUCAS® latest version, and 2021, the year in which the present study was initiated. Two exclusion criteria were applied: a searches conducted on animals, mannequins or through simulation, and integrative literature reviews or meta-analysis studies. The gathering of data took place between 7 September and 12 November 2021, and after the exclusion criteria were run 5 articles were selected from the 261 that were gathered. Results: The number of muscle, skeletal and soft tissue lesions were higher when chest compression was operated using LUCAS®. The restoring of blood flow was more frequent among patients treated with LUCAS® than in those treated by the means of manual chest compression. Cardiopulmonary resuscitation success rate was lower when using LUCAS® than when compression was manual. The using of LUCAS® entails higher costs in terms of health care and state aid. Neurological prognostication is better and with fewer complications after resuscitation among patients treated with manual chest compression. No significant differences arose between the two groups of patients as far as the average length of hospital stay, the need for intensive care, overall health and emotional wellbeing were concerned. Conclusions: The use of LUCAS® in the event of heart arrest does not seem to be more beneficial to patients than their treatment through manual chest compression. Research limitations were such as the uneven number of patients in both groups, the lack of information on the profile of participants, and the lack of knowledge regarding the medical crew’s revious experience and training using LUCAS®.Introdução: A paragem cardiorrespiratória é um evento crítico que cessa a circulação espontânea. Para restabelecer um fluxo sanguíneo capaz de manter os órgãos vitais viáveis são realizadas compressões torácicas, de forma manual ou através de um dispositivo mecânico. Objetivos: Analisar a evidência científica sobre o efeito do uso do dispositivo de compressão torácica mecânica LUCAS® em situação de paragem cardiorrespiratória. Materiais e Métodos: Revisão integrativa da literatura, com recurso às bases de dados eletrónicas PubMed, Medline, Cinahl e Cochrane, inserindo a equação: reanimação cardiopulmonar (cardiopulmonary resuscitation) AND compressão torácica mecânica (mechanical chest compression) AND LUCAS®, restringindo a pesquisa entre 2016, ano de lançamento da última versão do LUCAS®, e 2021, ano do início deste estudo. Foram aplicados dois critérios de exclusão: investigação realizada com recurso a animais, manequins ou simulações e estudos de revisão integrativa da literatura ou meta-análise. A colheita de dados compreendeu-se entre 7 de setembro de 2021 e 12 de novembro do mesmo ano. De 246 artigos obtidos e após aplicação dos critérios de exclusão foram selecionados 5 artigos. Resultados: Existe maior incidência de lesões músculo-esqueléticas e dos tecidos moles nas vítimas submetidas a compressões torácicas mecânicas. Ocorreu o retorno da circulação espontânea em maior número de vítimas reanimadas com o LUCAS® do que nas vítimas reanimadas com compressões torácicas manuais. A taxa de sucesso na reanimação cardiopulmonar foi menor nos casos reanimados com o LUCAS® e maior nas vítimas reanimadas com compressões torácicas manuais. A aplicação do LUCAS® implica custos mais elevados em termos de serviços de saúde e apoio social. As vítimas reanimadas com o LUCAS® apresentam pior prognóstico neurológico e mais complicações na fase pós-reanimação do que as vítimas reanimadas com compressões torácicas manuais. O tempo de internamento hospitalar, a necessidade de cuidados intensivos, a qualidade em saúde e o bem-estar emocional não apresentaram diferenças significativas quando comparados os grupos reanimados com compressões manuais ou com o LUCAS®. Conclusões: O recurso ao dispositivo de compressão torácica mecânica LUCAS®, durante uma paragem cardiorrespiratória, não evidencia mais vantagens para a vítima em comparação às CT manuais. Como limitações, verifica-se que as amostras são díspares no que diz respeito aos dois grupos de vítimas, existe falta de informação sobre o perfil dos participantes e é desconhecida a experiência e treino que as equipas têm relativamente ao dispositivo LUCAS®

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Branding strategies in the context of startup companies has been vaguely investigated. This is surprising since companies in the early startup phase recognize a need to quickly create brand equity in order to differentiate themselves from competitors to rise above the clutter in the market space. The objective of this study is therefore to investigate what branding strategies Swedish technology startup companies employ to create brand equity. Founders of four Swedish startup companies within the technology industry has been interviewed in order to gain insight in the context of startup companies and what branding strategies they employ. The authors present some common denominators between the branding strategies that are used. It is concluded that it is crucial for startups to create brand awareness. It is also recognized that startups rarely communicate company values. Instead, functional benefits and product characteristics are often communicated. Lastly, it appears that the overarching branding strategy of the studied startup companies is their emphasis on the importance of being perceived as different compared to competitors

Relatório vacinação estratégias de comunicação e literacia em saúde eficazes para população jovem

Um conjunto de duas dezenas de profissionais portugueses de várias áreas da saúde refletiu em conjunto sobre as questões que levam os jovens a não se interessarem pela vacinação contra o COVID-19 e a forma mais eficaz de se ultrapassarem estas crenças negativas e barreiras à vacinação. As preocupações destes jovens sobre os efeitos seguros da vacinação, a proteção de familiares e amigos e o regresso às atividades sociais parecem ser fatores motivadores para a ação de vacinação e proteção. Neste sentido, e reunindo o conhecimento sobre as campanhas de marketing em saúde e os conteúdos comunicativos que podem influenciar positivamente esta mobilização para a vacinação, estes profissionais apresentam neste relatório um conjunto de dados científicos, estratégicos e operacionais que podem apontar alguns caminhos. Este grupo de trabalho avaliou o perfil dos jovens (dados demográficos e psicográficos), as crenças, as necessidades, a perceção do risco e as motivações que podem ser atendidas para que se criem, com a brevidade possível, através dos recursos públicos e das autoridades sanitárias, onde se inclui a Direção-Geral da Saúde (DGS), formas de melhor promover os objetivos inequívocos: vacinar a população jovem em Portugal com a brevidade possível.info:eu-repo/semantics/publishedVersio

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status