Factors influencing implementation of ehealth technologies to support informal dementia care:Umbrella review

Background: The worldwide increase in community-dwelling people with dementia underscores the need for innovative eHealth technologies that aim to provide support to both patients and their informal caregivers in the home setting. However, sustainable implementation of eHealth technologies within this target group can be difficult. Objective: The goal of this study was to gain a thorough understanding of why it is often difficult to implement eHealth technologies in practice, even though numerous technologies are designed to support people with dementia and their informal caregivers at home. In particular, our study aimed to (1) provide an overview of technologies that have been used and studied in the context of informal dementia care and (2) explore factors influencing the implementation of these technologies. Methods: Following an umbrella review design, five different databases were searched (PubMed, PsycINFO, Medline, Scopus, and Cochrane) for (systematic) reviews. Among 2205 reviews retrieved, 21 were included in our analysis based on our screening and selection procedure. A combination of deductive and inductive thematic analyses was performed, using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework for organizing the findings. Results: We identified technologies designed to be used “by informal caregivers,” “by people with dementia,” and “with people with dementia.” Within those groups, most of the represented technologies included, respectively: (i) devices for in-home monitoring of lifestyle, health, and safety; (ii) technologies for supporting memory, orientation, and day structure; and (iii) technologies to facilitate communication between the informal caregiver and person with dementia. Most of the identified factors influencing implementation related to the condition of dementia, characteristics of the technology, expected/perceived value of users, and characteristics of the informal caregiver. Considerably less information has been reported on factors related to the implementing organization and technology supplier, wider institutional and sociocultural context of policy and regulations, and continued adaptation of technology over time. Conclusions: Our study offers a comprehensive overview of eHealth technologies in the context of informal dementia care and contributes to gaining a better understanding of a broad range of factors influencing their implementation. Our results uncovered a knowledge gap regarding success factors for implementation related to the organizational and broader context and continuous adaptation over the long term. Although future research is needed, the current findings can help researchers and stakeholders in improving the development and implementation of eHealth technologies to support informal dementia care

Transportadores de ácidos orgânicos na tolerância ao alumínio tóxico em trigo

Aluminum (Al) toxicity in plants is seen in about 15% of the soils worldwide, restraining yields in arable land. In Brazil, acidic soils limit production of wheat (Triticum aestivum L.) and other cereals. Al is toxic for most winter cereals when its concentration increases and soil pH is below 5. One of the main concerns with acidic soil is the increase in the mobility of Al3+ions. Al binds to cell walls in roots, preventing meristematic elongation in sensitive species, causing damage to the root system and results in lower yields. Al3+ forms highly stable complexes with phosphorus (P), limiting its availability to plants, as well as reducing cell division and elongation. To deal with Al toxicity, plants have developed strategies such as organic acid (OA) exudation by roots; this mechanism of detoxification has been well-characterized. OAs, in turn, chelate ions Al3, forming non-toxic compounds that do not penetrate the root system. Some genes responsible for Al tolerance in wheat have been identified, particularly TaALMT1 and TaMATE1B that transport malate and citrate OAs, respectively. In this review, we discussed the mechanisms by which Al damages roots those by which plants are protected, primarily through two genes. We also described the interaction of the ALMT1 gene with P and iron (Fe).A toxicidade do alumínio (Al) às plantas é observada em cerca de 15% dos solos no planeta, sendo um fator restritivo à produtividade em terras cultiváveis. No Brasil, os solos ácidos são limitantes à produção de trigo (Triticum aestivum L.) e outros cereais. O Al é tóxico para a maioria dos cereais de inverno, quando a sua concentração aumenta e o pH do solo atinge valores inferiores a 5. Uma das principais preocupações sobre o solo ácido é o aumento da mobilidade dos íons Al3+. O Al pode se ligar as paredes celulares das raízes e, como consequência, impedir o alongamento meristemático em espécies sensíveis, provocando danos ao sistema radicular, que resulta em menor desempenho agronômico das plantas. O Al3+ é também capaz de formar complexos altamente estáveis com fósforo (P), limitando sua disponibilidade para as plantas, e também reduzindo a divisão e o alongamento celular. Para lidar com a toxicidade ao Al, as plantas desenvolveram algumas estratégias como a exsudação de ácido orgânicos (AOs) pelas raízes, sendo este mecanismo de destoxificação bem caracterizado. Os AOs, por sua vez, quelam ions Al3+ formando compostos não tóxicos que não penetram no sistema radicular. Alguns genes responsáveis pela tolerância ao Al em trigo foram identificados, com ênfase para TaALMT1 e TaMATE1B, que exsudam os AOs malato e citrato, respectivamente. Nesta revisão, discutimos os mecanismos pelos quais Al danifica raízes, bem como plantas protegem-se, através de dois genes principalmente. Também apresentamos a interação do gene ALMT1 com P e ferro (Fe)

Avaliação microbiológica de fórmulas infantis manipuladas em Unidade Centralizada de Produção

A contaminação dos alimentos servidos nos hospitais pode ocorrer durante o preparo, transporte, armazenamento e administração. As fórmulas infantis à base de leite são produtos, líquidos ou em pó, destinados à alimentação de crianças ou recém-nascidos quando não puder ser utilizado o leite materno ou humano. No hospital, essas fórmulas são geralmente manipuladas no lactário ou em Unidades Centralizadas de Produção terceirizadas. A manipulação de fórmulas infantis deve receber atenção especial considerando que os pacientes a quem são destinados são, geralmente, mais suscetíveis a infecções, a desidratação e suas conseqüências. O objetivo do estudo consistiu em avaliar a carga microbiana de fórmulas infantis segundo parâmetros da RDC 63 e RDC 12 em diferentes intervalos de tempo e faixas de temperatura por até 40 horas após o preparo. Os resultados mostraram que fórmulas preparadas em condições higiênicas sanitárias adequadas garantem a qualidade final das formulações por até 40 horas após o horário de preparo, quando mantidas sob-refrigeração com temperaturas entre 2 a 80 C. E, as formulações podem ficar até 6 horas à temperatura ambiente média de 23 a 250 C. Podemos concluir que este estudo ratificou a necessidade da aplicação efetiva de pré-requisitos higiênico-sanitários utilizados durante a cadeia produtiva de preparo das fórmulas infantis para lactentes resultando em um produto seguro do ponto de vista microbiológico

EFICÁCIA DA ESPECTROSCOPIA POR ULTRASSOM E DO CONGELAMENTO NA AVALIAÇÃO DA COMPOSIÇÃO QUÍMICA DO LEITE

Objetivou-se avaliar o método de espectroscopia por ultrassom (EU) e o efeito do congelamento do leite nas análises de gordura e proteína do leite de vaca. Cem amostras foram analisadas imediatamente após a coleta em tanque de expansão (in natura), congeladas a -20ºC por 30 dias e novamente analisadas por métodos oficiais (gordura por butirômetro de Gerber e proteína por micro-Kjeldahl) e por EU. Observou-se efeito de interação (P < 0,01) entre o método analítico e congelamento do leite. A EU superestimou (P < 0,01) o teor de gordura e subestimou (P < 0,01) o teor de proteína no leite in natura ou congelado. O congelamento não afetou (P = 0,15) o teor de gordura obtido pelo método oficial, mas reduziu o teor de gordura (P < 0,01) obtido com a EU. O congelamento aumentou (P < 0,01) o teor de proteína obtido pelo método oficial, mas reduziu (P < 0,01) quando obtido por EU. Os teores de gordura e proteína do leite obtidos pelo método de EU são divergentes daqueles obtidos por métodos oficiais, independente da amostra ser in natura ou congelada.Palavras-chave: método analítico; análise química; correlação. EFFICACY OF ULTRASONIC SPECTROSCOPY AND FREEZING IN EVALUATION OF MILK CHEMICAL COMPOSITION ABSTRACT: The objective was to evaluate the ultrasound spectroscopy (US) method and the effect of milk freezing on the cow's milk fat and protein analysis. One hundred samples were collected from one milk tank, immediately analyzed, and frozen at -20ºC for 30 days and analyzed again by official method (fat: Gerber butyrometer, protein: micro-Kjeldahl) and US. It was observed effect of interaction (P < 0.01) between analytical method and milk freezing. Ultrasound spectroscopy overestimated milk fat content and underestimated milk protein content on in natura or frozen. The milk freezing for 30 days did not affect the milk fat content obtained by official method (P = 0.15), but it reduced the milk fat content (P < 0.01) obtained by US. The milk freezing increased (P < 0.01) the milk protein content obtained by official method, but reduced (P <0.01) when obtained from US. The milk fat and protein content obtained by US are different from those obtained by official methods, regardless of the sample is in natura or frozen.Keywords: analytical method; chemical analysis; correlation

Grupet - grupo de estudo em animais de companhia: a capacitação através da extensão/Grupet - study group on companion animals: training through extension

O Grupet é um grupo de estudo, coordenado por docentes e desenvolvido por discentes voluntários do curso de medicina veterinária. O grupo realiza palestras, cursos, ações de atendimento médico laboratorial e de orientação sobre criação de animais junto à comunidade, e de forma contínua no hospital veterinário, principalmente de animais errantes ou em situação de vulnerabilidade. Os alunos participantes atuam como multiplicadores de conhecimento, organizando e ministrando palestras, além de participar na consulta médica, realização de exames laboratoriais, procedimento cirúrgico e tratamento de animais enfermos da comunidade carente e de animais errantes, consolidando o conhecimento teórico adquirido e promovendo a extensão universitária. O projeto proporciona a interdisciplinaridade, capacitação teórica e prática dos alunos; difusão de conhecimento sobre animais de companhia à discentes, profissionais e à comunidade, visando promover a saúde e bem estar animal em benefício da população, como também, a formação técnica e a experiencia social dos alunos de medicina veterinária

Um ano de pandemia: experiência do Serviço de Nutrição e Dietética de um hospital de referência para atendimento de covid-19

Introduction: The 2019 coronavirus disease (COVID-19) pandemic brought changes in work organization in all spheres, requiring the restructuring of routines and teams to meet this new demand. The aim of study was to report the experience of the Nutrition and Dietetics Department (NDD) of Hospital de Clínicas de Porto Alegre (HCPA) and the changes that occurred during the first year of the COVID-19 pandemic. Methods: This is an experience report of the performance of HCPA NDD from April 2020 to March 2021. Results: There was an increase in absenteeism in the NDD, requiring processadjustments and relocations. There was also an increase in enteral nutrition delivery due to the severity of the clinical condition of hospitalized patients, a reduction in the capacity of employees’ cafeteria to meet distancing protocols, and a need to use disposable utensils, deliver motivational messages to patients, make adjustmentsto the human milk bank process, and implement changes in nutritional assessment protocols for inpatients and remote outpatient care.  Conclusion: This experience provided the NDD with a great legacy of learning and overcoming by requiring the NDD to adapt while maintaining quality service and strengthening teamwork relationships.Introdução: A pandemia de coronavírus 2019 (COVID-19) trouxe mudanças nas organizações de trabalho em todas as esferas, exigindo a reestruturação das rotinase das equipes para atender essa nova demanda. O objetivo foi relatar a experiência do Serviço de Nutrição e Dietética (SND) do Hospital de Clínicas de Porto Alegre(HCPA) e as mudanças vivenciadas durante o primeiro ano de pandemia de COVID-19.Métodos: Trata-se de um relato de experiência referente à atuação do SND do HCPA de abril de 2020 a março de 2021.Resultados: Houve aumento do absenteísmo no SND, necessitando ajustes de processos e remanejos. Também houve aumento do consumo de dietas enterais pelagravidade da situação clínica dos pacientes internados, a redução da capacidade do refeitório de funcionários para seguir os protocolos de distanciamento, o uso deutensílios descartáveis, mensagens motivacionais aos pacientes, ajustes no processo do banco de leite humano, modificações nos protocolos de avaliação nutricional ao paciente internado e atendimento ambulatorial remoto.Conclusão: Esta experiência proporcionou ao SND um grande legado de aprendizagem e superação, exigindo importantes adaptações, mantendo a qualidade do atendimento e fortalecendo as relações de trabalho em equipe

Analysis of anti-Mullerian hormone (AMH) and its receptor (AMHR2) genes in patients with persistent Mullerian duct syndrome

Objective: To screen for mutations in AMH and AMHR2 genes in patients with persistent Mullerian duct syndrome (PMDS). Patients and method: Genomic DNA of eight patients with PMDS was obtained from peripheral blood leukocytes. Directed sequencing of the coding regions and the exon-intron boundaries of AMH and AMHR2 were performed. Results: The AMH mutations p.Arg95*, p.Arg123Trp, c.556-2A>G, and p. Arg502Leu were identified in five patients; and p.Gly323Ser and p.Arg407* in AMHR2 of two individuals. In silico analyses of the novel c.556-2A>G, p.Arg502Leu and p.Arg407* mutations predicted that they were harmful and were possible causes of the disease. Conclusion: A likely molecular etiology was found in the eight evaluated patients with PMDS. Four mutations in AMH and two in AMHR2 were identified. Three of them are novel mutations, c.556-2A>G, and p. Arg502Leu in AMH; and p.Gly323Ser in AMHR2. Arq Bras Endocrinol Metab. 2012;56(8):473-8Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) [305743/2011-2, 314392/2009-2, 302084/2009-6]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (Fapesp) [06/50999-0]Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP

Stewardship program for restricted use of antimicrobials in the elderly: a cohort study in a quaternary hospital in Brazil

Objective: The stewardship strategy refers to a consistent practice to promoting responsible antimicrobial use. Optimizing the use of antibiotics is critical to mitigating adverse effects and combating bacterial resistance. The pillars of a stewardship program include: i) clinical pharmacist and infectologist with expertise; ii) educational measures for prescribers, nurses and pharmacists; iii) prophylaxis and therapeutic protocol; iv) monitoring of indicators. In this scenario of antimicrobial rational use, the older population are more susceptible to infection because immunocenescence and, therefore, greater use of antimicrobials is expected. Thus, the aim of the present study is to evaluate the prescription compliance of antimicrobial whose use is restricted in a hospitalized elderly population. Method: observational, controlled study in a Brazilian hospital, from January 2021 to January 2022. Based on the electrotonic antimicrobial form, the compliance of the prescriptions was evaluated. The definition used for elderly corresponded to individuals over 60 years old, according to the Brazilian Nation Principles for Older Persons, ordinance number 2528, of October 2006. Restricted drugs were considered: carbapenems, polymyxin, ceftazidime-avibactam, linezolid, tigecycline, ceftaroline, echinocandins and amphotericin. Results: A total of 1.688 requests for restricted use were received, of which 53% corresponded use in elderly group. Neutropenic fever was more common in young people and the inpatient unit was the sector with the highest percentage of antimicrobials. Furthermore, teicoplanin was the main drug that required intervention. Conclusion: Faced with the increase in bacterial resistance, the rational use of antimicrobials is extremely important, especially in older age group

Analysis of anti-Mullerian hormone (AMH) and its receptor (AMHR2) genes in patients with persistent Mullerian duct syndrome

Objective: To screen for mutations in AMH and AMHR2 genes in patients with persistent Mullerian duct syndrome (PMDS). Patients and method: Genomic DNA of eight patients with PMDS was obtained from peripheral blood leukocytes. Directed sequencing of the coding regions and the exon-intron boundaries of AMH and AMHR2 were performed. Results: The AMH mutations p.Arg95*, p.Arg123Trp, c.556-2A>G, and p. Arg502Leu were identified in five patients; and p.Gly323Ser and p.Arg407* in AMHR2 of two individuals. In silico analyses of the novel c.556-2A>G, p.Arg502Leu and p.Arg407* mutations predicted that they were harmful and were possible causes of the disease. Conclusion: A likely molecular etiology was found in the eight evaluated patients with PMDS. Four mutations in AMH and two in AMHR2 were identified. Three of them are novel mutations, c.556-2A>G, and p. Arg502Leu in AMH; and p.Gly323Ser in AMHR2. Arq Bras Endocrinol Metab. 2012;56(8):473-8Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) [305743/2011-2, 314392/2009-2, 302084/2009-6]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (Fapesp) [06/50999-0]Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP