Sexual Quality of Life-Female (SQoL-F): Cultural Adaptation and Validation of European Portuguese Version

O questionário de Qualidade de Vida Sexual Feminina (SQoL-F) foi desenvolvido com dados qualitativos para avaliar o impacto da disfunção sexual em mulheres. Objetivos: o objetivo foi realizar uma adaptação transcultural e análise psicométrica de uma versão em português europeu do questionário Sexual Quality of Life-Female. Métodos: Estudo metodológico dos processos de tradução e adaptação cultural. Trata-se de um estudo retrospectivo do qual participaram estudantes de enfermagem. Recolha de dados: A plataforma Lime Survey numa amostra de conveniência foi realizada em duas fases, sendo a última o re-teste dos dados. O instrumento analisado, apresentado como variável latente, é composto por 18 itens em escala Likert. O estudo foi aprovado pelo Comitê de Ética. Participantes: a amostra foi de 113 mulheres, idade média 21,99 anos (±3,76), frequência das aulas nos primeiros 4 anos do primeiro ciclo de enfermagem. Resultados: Foi analisada a confiabilidade e encontrada estabilidade no teste-reteste (rs = 0,658) e no coeficiente intraclasse (rs = 0,821). A análise de consistência interna apresentou um valor alfa de 0,846. A análise da validade discriminante por meio do teste de Mann-Whitney revelou maior escore de qualidade de vida sexual de estudantes que vivem com pais/substitutos. A análise da validade fatorial foi realizada usando a rotação Oblimin com testes de quatro, três e dois fatores. A análise paralela da matriz empírica em comparação com a matriz aleatória mostrou que o instrumento é unidimensional. Conclusões: a avaliação das propriedades do SQoL-F é valiosa, pois o fornecimento de um instrumento válido e confiável contribui para a qualidade dos estudos subsequente

Sexual Education: European Health Promotion. Training Guide

Working on sexual education is one of the most pressing, but also one of the most difficult issues facing today’s educational systems. Reflecting these challenges in an international project is an excellent opportunity to find new reflections and approaches. From a holistic, properly contextualized perspective, the EdSeX project presents well-founded work suggestions that make us think about what is expected from sexual education, from childhood to higher education, reflecting the training of professionals who work in area of health and education. There are many issues associated with sexuality that continue to concern us and that need to be addressed from childhood. Sexual identity begins to be defined early, and it is also early that stereotypical ideas begin to be constructed. After many years in which biological determinism prevailed that considered the nature of men to be different from the nature of women, the concept of gender considers that the cultural issues associated with sexual identity are a social construct. Conceiving the definition of gender, in a broad, multidimensional sense, taking into account identity, sexual orientation, personal skills and interests, the deconstruction of stereotypical ideas is the basis for building greater equity between everyone from childhood. This process implies that sexual education begins by building a critical knowledge of oneself and of others, in the recognition of diversity, from a citizenship perspective. Knowledge of oneself and of the other is also the basis for understanding the social context and the variables that characterize it, namely the risks that an uninformed sexuality can entail. The prevention of sexual and emotional violence starts early and must be worked on constructively at the various levels of education, without forgetting higher education and the training of future health and education professionals who will have to do this work with increasingly diverse audiences. In this complex context, having a support script based on diverse experiences is excellent guidance that the EdSeX project provides us. This Guide promotes sexual education as a dynamic learning process, from a dialogical perspective, giving visibility to sexual, linguistic and cultural diversity, using digital media in a constructive and critical way. In addition to the work resources provided, the project has the added value of the methodological part built that leaves the way open for the development of the work already started in the different countries involved, in terms of training and research. May the EdSeX project be the basis for the construction of many more projects!info:eu-repo/semantics/publishedVersio

Educación sexual: promoción de la salud europea. Guía formativa

Trabajar en educación sexual es una de las cuestiones más apremiantes, pero también una de las más difíciles, a las que se enfrentan los sistemas educativos en la actualidad. Reflejar estos desafíos en un proyecto internacional es una excelente oportunidad para encontrar nuevas reflexiones y enfoques. Desde una perspectiva holística y adecuadamente contextualizada, el proyecto EdSeX presenta fundamentadas sugerencias de trabajo que nos hacen pensar en lo que se espera de la educación sexual, desde la infancia hasta la educación superior, reflejando la formación de los profesionales que actúan en el área de la salud y educación. Hay muchas cuestiones asociadas a la sexualidad que nos siguen preocupando y necesitan ser abordadas desde la infancia. La identidad sexual comienza a definirse tempranamente, y también es temprano cuando se comienzan a construir ideas estereotipadas. Luego de muchos años en los que prevaleció el determinismo biológico, considerando la naturaleza de los hombres como diferente a la de las mujeres, el concepto de género considera que las cuestiones culturales asociadas a la identidad sexual son una construcción social. Concebiendo la definición de género, en un sentido amplio y multidimensional, teniendo en cuenta la identidad, la orientación sexual, las capacidades y los intereses personales, la deconstrucción de ideas estereotipadas es la base para construir una mayor equidad entre todos desde la niñez. Este proceso implica que la educación sexual comienza con la construcción del conocimiento crítico de uno mismo y de los demás, en el reconocimiento de la diversidad, desde una perspectiva de ciudadanía. El conocimiento de uno mismo y de los demás es también la base para comprender el contexto social y las variables que lo caracterizan, es decir, los riesgos que puede conllevar una sexualidad desinformada. La prevención de la violencia sexual y emocional comienza temprano y debe trabajarse de manera constructiva en los diferentes niveles educativos, sin olvidar la educación superior y la formación de los futuros profesionales de la salud y la educación que tendrán que hacer esta labor con públicos cada vez más diversos. En este contexto complejo, contar con una hoja de ruta de apoyo basada en diversas experiencias es una excelente guía que nos brinda el proyecto EdSeX. Esta Guía promueve la educación sexual como un proceso de aprendizaje dinámico, desde una perspectiva dialógica, dando visibilidad a la diversidad sexual, lingüística y cultural, utilizando los medios digitales de manera constructiva y crítica. Además de los recursos de trabajo aportados, el proyecto tiene el valor añadido de la parte metodológica construida que deja abierto el camino al desarrollo de los trabajos ya iniciados en los diferentes países implicados, en materia de formación e investigación. ¡Que el proyecto EdSeX sea la base para la construcción de muchos más proyectos!info:eu-repo/semantics/publishedVersio

Educazione sessuale: promuovere la salute europea. Guida alla formazione

Lavorare sull’educazione sessuale è uno dei temi più urgenti, ma anche uno dei più difficili da affrontare i sistemi educativi di oggi si trovano a confrontarsi. Riflettere queste sfide in un progetto internazionale è a ottima occasione per trovare nuove riflessioni e approcci. Da una prospettiva olistica, opportunamente contestualizzata, il progetto EdSeX presenta suggerimenti piani di lavoro ben fondati che ci fanno riflettere su cosa ci si aspetta dall’educazione sessuale, da infanzia, fino all’istruzione superiore, riflettendo la formazione dei professionisti che operano nel settore sanitario e formazione scolastica. Ci sono molte questioni legate alla sessualità che continuano a preoccuparci e che ne hanno bisogno su cui lavorare fin dall’infanzia. L’identità sessuale comincia a definirsi presto, ed è presto anche quello costruire idee stereotipate. Dopo molti anni in cui prevaleva il determinismo biologico chi riteneva che la natura degli uomini fosse diversa dalla natura delle donne, il concetto di genere ritiene che le questioni culturali legate all’identità sessuale siano un costrutto sociale. Concepire il definizione di genere, in senso ampio e multidimensionale, tenendo conto dell’identità, dell’orientamento sessuale, competenze e interessi personali, la decostruzione delle idee stereotipate è la base per costruire di maggiore uguaglianza tra tutti fin dall’infanzia. Questo processo implica che l’educazione sessuale inizi con la costruzione di una conoscenza critica di sé e degli altri, nel riconoscimento della diversità, in una prospettiva di cittadinanza. La conoscenza di sé e gli altri, costituisce anche la base per la conoscenza del contesto sociale e delle variabili che lo caratterizzano, vale a dire i rischi che la sessualità non informata può comportare. La prevenzione della violenza sessuale ed emotiva inizia presto e occorre lavorarci sopra modo costruttivo ai diversi livelli di istruzione, senza dimenticare l’istruzione superiore e la formazione dei futuri/ professionisti della sanità e dell’istruzione che dovranno svolgere questo lavoro con sempre maggiore frequenza diversificato. In questo contesto complesso, avere una Guida di supporto basata su esperienze diverse è importante eccellente guida che il progetto EdSeX ci fornisce. Questa Guida promuove l’educazione sessuale come processo di apprendimento dinamico, da una prospettiva prospettiva dialogico, dando visibilità alla diversità sessuale, linguistica e culturale, utilizzando i mezzi digitali modo costruttivo e critico. Oltre alle risorse lavorative previste, il progetto ha il valore aggiunto della parte metodologica costruita che lascia la strada aperta allo sviluppo del lavoro già avviato nei diversi paesi coinvolti, il livello di formazione e ricerca. Possa il progetto EdSeX essere la base per la costruzione di tanti altri progetti!N/

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe

Probing effective field theory operators in the associated production of top quarks with a Z boson in multilepton final states at root s=13 TeV

Peer reviewe