A qualidade de vida de pessoas com esclerose múltipla em Portugal

Highlights The interest in the quality of life of people suffering from multiple sclerosis in Portugal is relatively recent, and the impact of this condition has been confined to the assessment of the disability it causes among patients. Multiple sclerosis is considered the most frequent non-traumatic cause of disability among young adults aged between 20 and 40, and evidence shows that the highest incidence is observed among women. The variables with the highest predictive weight are those that have a negative impact on the physical domain and the social domain, both explaining 59.00% and 53.00% of the variability, respectively. Understanding the quality of life of people with multiple sclerosis and its associated variables enables the implementation of specific and effective nursing care programmes designed to promote patient well-being. Introduction: Multiple sclerosis significantly affects the quality of life of those suffering from this specific condition. Objective: To assess the quality of life of people with multiple sclerosis and analyse the correlation between the disease and its associated effects and different sociodemographic, clinical, and functional variables. Materials and Methods: An observational, cross-sectional, descriptive-correlational and quantitative study conducted using a non-probabilistic convenience sample composed of 70 patients suffering from multiple sclerosis registered with the Multiple Sclerosis Association of the Central Region of Portugal. The data collection protocol included sociodemographic and clinical questions, the Family Apgar Scale, and the Barthel Index. Descriptive and inferential statistics were used to process the data. Data collection took place between April and July 2021. Results:  The majority of participants reported a moderate overall quality of life (M=51,78 ± 24,09). Higher scores were observed in the social relationships and environmental health domains, while lower scores were recorded for the physical domain. Better quality of life was found to be positively associated with being under 45 years old, having higher educational qualifications, living in functional families, and experiencing greater functional independence in activities of daily living. Discussion: The variables with the strongest association were those capable of influencing the physical and social domains. Those variables explained 59.00% and 53.00% of the variability.   Conclusions: These results indicate that people with multiple sclerosis have a compromised quality of life, highlighting the need for new strategies focusing on early diagnosis and effective preventive interventions meant to improve quality of life across all its domains. How to cite this article: Martins Rosa, Gomes Sara, Vicente Patrícia, Carvalho Nélia, Batista Susana. The quality of life of people with multiple sclerosis in Portugal. Revista Cuidarte. 2024;15(2):e2841. https://doi.org/10.15649/cuidarte.2841Introducción: La esclerosis múltiple afecta significativamente la calidad de vida de las personas que padecen la enfermedad. Objetivo: Evaluar la calidad de vida de personas con esclerosis múltiple y analizar la asociación con variables sociodemográficas clínicas y funcionales. Materiales y Métodos: Estudio observacional, transversal, descriptivo-correlacional y cuantitativo que utilizó una muestra no probabilística por conveniencia, compuesta por 70 pacientes con esclerosis múltiple, registrados en la Asociación de Esclerosis Múltiple de la Región Central de Portugal. El protocolo de recolección de datos contuvo preguntas sociodemográficas y clínicas, la Escala de Apgar familiar y el Índice de Barthel. En el procesamiento de los datos se utilizó estadística descriptiva e inferencial y la recolección se realizó entre abril y julio de 2021. Resultados: La mayoría de los participantes presentan una calidad de vida general moderada (M=51,78 ± 24,09), con puntuaciones más altas en las relaciones sociales y dominios ambientales y menores en el dominio físico. Una mejor calidad de vida se asoció con una edad inferior a 45 años, mayor nivel educativo, familias funcionales y mayor independencia funcional en las actividades de la vida diaria. Discusión:   Las variables con asociación más robusta son las que influyen en el dominio físico y en el dominio social, que explican, en total, el 59,00% y el 53,00% de su variabilidad. Conclusiones: Estos resultados indican que las personas con esclerosis múltiple tienen una calidad de vida comprometida, fortaleciendo la necesidad de implementar nuevas estrategias de diagnóstico precoz e intervenciones preventivas efectivas, potenciando una mejor calidad de vida, en todos los ámbitos que la constituyen. Como citar este artículo: Martins Rosa, Gomes Sara, Vicente Patrícia, Carvalho Nélia, Batista Susana. A qualidade de vida de pessoas com esclerose múltipla em Portugal. Revista Cuidarte. 2024;15(2):e2841.  https://doi.org/10.15649/cuidarte.2841Highlights O interesse pela qualidade de vida das pessoas com Esclerose Múltipla em Portugal é relativamente recente e o impacto da doença tem sido limitado à avaliação da incapacidade causada. A esclerose múltipla é considerada a causa não traumática mais frequente de incapacidade no adulto jovem, entre os 20 e os 40 anos, com maior incidência nas mulheres. As variáveis com maior peso preditivo são as que influenciam o domínio físico e o domínio social explicando no seu total, 59,00% e 53,00% respetivamente da variabilidade. Conhecer a qualidade de vida e variáveis associadas, na pessoa com esclerose múltipla permite estabelecer programas específicos e eficazes de cuidados de enfermagem na promoção do bem-estar do paciente. Introdução: A esclerose múltipla afeta de forma bastante significativa a qualidade de vida das pessoas portadoras da doença. Objetivo: Aavaliar a qualidade de vida da pessoa com esclerose múltipla e analisar a associação com variáveis sociodemográficas clínicas e funcionais. Materiais e Métodos: Estudo observacional, transversal, descritivo-correlacional e de cariz quantitativo que utilizou uma amostra do tipo não probabilístico por conveniência, constituída por 70 doentes com esclerose múltipla, inscritas na Associação de Esclerose Múltipla da Região Centro de Portugal. O protocolo de recolha de dados continha questões sociodemográficas, clinicas, a Escala de Apgar familiar e o Índice de Barthel. Foi utilizada estatística descritiva e inferencial no tratamento de dados e a colheita foi efetuada entre abril e julho de 2021. Resultados: A maioria dos participantes apresenta qualidade de vida global moderada (M=51,78 ± 24,09), com scores mais elevados nos domínios relações sociais e ambiente e mais baixos no domínio físico. A melhor qualidade de vida estava associada, a idade inferior a 45anos, habilitações literárias superiores, famílias funcionais e maior independência funcional nas atividades de vida diária. Discussão: As variáveis com associação mais robusta são as que influenciam o domínio físico e o domínio social que explicam, no seu total, 59,00% e 53,00% da sua variabilidade. Conclusões: Estes resultados indicam que as pessoas com esclerose múltipla apresentam uma qualidade de vida comprometida, fortalecendo a necessidade de implementar novas estratégias de diagnóstico precoce e intervenções preventivas eficazes, potenciadoras de melhor qualidade de vida, em todos os domínios que a constituem. Como citar este artigo: Martins Rosa, Gomes Sara, Vicente Patrícia, Carvalho Nélia, Batista Susana. A qualidade de vida de pessoas com esclerose múltipla em Portugal. Revista Cuidarte. 2024;15(2):e2841.  https://doi.org/10.15649/cuidarte.284

A soft computing approach to kidney diseases evaluation

Kidney renal failure means that one’s kidney have unexpectedly stopped functioning, i.e., once chronic disease is exposed, the presence or degree of kidney dysfunction and its progression must be assessed, and the underlying syndrome has to be diagnosed. Although the patient’s history and physical examination may denote good practice, some key information has to be obtained from valuation of the glomerular filtration rate, and the analysis of serum biomarkers. Indeed, chronic kidney sickness depicts anomalous kidney function and/or its makeup, i.e., there is evidence that treatment may avoid or delay its progression, either by reducing and prevent the development of some associated complications, namely hypertension, obesity, diabetes mellitus, and cardiovascular complications. Acute kidney injury appears abruptly, with a rapid deterioration of the renal function, but is often reversible if it is recognized early and treated promptly. In both situations, i.e., acute kidney injury and chronic kidney disease, an early intervention can significantly improve the prognosis.The assessment of these pathologies is therefore mandatory, although it is hard to do it with traditional methodologies and existing tools for problem solving. Hence, in this work, we will focus on the development of a hybrid decision support system, in terms of its knowledge representation and reasoning procedures based on Logic Programming, that will allow one to consider incomplete, unknown, and even contradictory information, complemented with an approach to computing centered on Artificial Neural Networks, in order to weigh the Degree-of-Confidence that one has on such a happening. The present study involved 558 patients with an age average of 51.7 years and the chronic kidney disease was observed in 175 cases. The dataset comprise twenty four variables, grouped into five main categories. The proposed model showed a good performance in the diagnosis of chronic kidney disease, since the sensitivity and the specificity exhibited values range between 93.1 and 94.9 and 91.9–94.2 %, respectively

Geomorphic markers of Quaternary tectonics in Westernmost Iberia: insights from the Lower Mondego River terraces (central Portugal)

The Lower Mondego Valley (LMV), located in the Western Iberian passive margin which is under compressive tectonic reactivation since ca. 80 Ma, is used for deciphering long-term landscape evolution during the Quaternary and the control played by active tectonics, eustasy and climate. The elaboration of a detailed geomorphological map allowed the establishment of the spatial and temporal distribution of the different geomorphological units and morphogenetic systems operating in the LMV. The culminant unit of the Mondego Cenozoic Basin (allostratigraphic unit UBS13, recording an Atlantic fan-delta and adjacent shallow marine siliciclastic environments) and terrace levels (river and marine) are used as geomorphic markers to quantify fluvial development and tectonic activity. The main stages of evolution are a transition of endorheic to exorheic (Atlantic base level) drainage in the Mondego Cenozoic Basin, ca. 3.7 Ma ago, followed by onset of the fluvial incision stage (valley entrenchment) by ca. 1.8 Ma. Electron spin resonance (ESR) dating is used to improve the chronological framework for the terrace staircases of the LMV and to decipher the response of the river to the regional uplift and other longterm controls (resistance of the substratum to erosion, eustasy and climate). Six river terrace levels (T1, the older, to T6, the younger), inset in the UBS13 and previous to the modern alluvial plain, were characterized and correlated with marine terraces represented at Cape Mondego, near the river mouth. The fluctuating eustatic and climate controls are superimposed on a long-term crustal uplift. The data show marked compartmentalization of fluvial system behaviour with changes in incision rates (acting as a proxy of uplift rates) from east to west, creating distinctly different sectors. Differential uplift is inferred between the valley sides and between the four main reaches in which the LMV is subdivided by major faults. Differential uplift is mainly related to regional fault sets trending N-S to NNW-SSE, NNE-SSW, ENE-WSW, and E-W to WNW-ESE. Using as geomorphic references the topmost deposits of the UBS13 unit and river terraces located above the alluvial plain, average long term incision rates were estimated ranging from 0.03 to 0.16 m/ka, dependin

Incorporation of curcumin-loaded solid lipid nanoparticles into yogurt:Tribo-rheological properties and dynamic in vitro digestion

The incorporation of nanostructures loaded with bioactive compounds into food matrices is a promising approach to develop new functional foods with improved nutritional, health profiles and good sensorial properties. The rheological and tribological properties of yogurt enriched with curcumin-loaded solid lipid nanoparticles (SLN) were evaluated. Also, the TCA solubility index, the bioaccessibility of curcumin and cell viability were assessed after dynamic in vitro digestion. The presence of SLN in yogurt did not affect its rheological properties; however, SLN addition increased the lubrication capability of yogurt. After in vitro digestion, yogurt with added SLN (yogurt_SLN) presented a lower TCA solubility index (22 %) than the plain yogurt (39 %). The bioaccessibility and stability of curcumin were statistically similar for yogurt_SLN (30 % and 42 %, respectively) and SLN alone (20 % and 39 %, respectively). Regarding cell viability results, the intestinal digesta filtrates of both controls (i.e., SLN alone and plain yogurt) did not affect significantly the cell viability, while the yogurt_SLN presented a possible cytotoxic effect at the concentrations tested. In general, the incorporation of SLN into yogurt seemed to promote the mouthfeel of the yogurt and did not adversely affect the bioaccessibility of curcumin. However, the interaction of SLN and yogurt matrix seemed to have a cytotoxic effect after in vitro digestion, which should be further investigated. Despite that, SLN has a high potential to be used as nanostructure in a functional food as a strategy to increase the bioactive compounds bioaccessibility.Raquel F. S. Gonçalves and Jean-Michel Fernandes acknowledges the Foundation for Science and Technology (FCT) for their fellowships (SFRH/BD/140182/2018 and SFRH/BD/147286/2019, respectively). Joana T. Martins acknowledges FCT for her Assistant Researcher Contract (2022.00788.CEECIND). This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UIDB/04469/2020 unit, and by LABBELS – Associate Laboratory in Biotechnology, Bioengineering and Microelectromechanical Systems, LA/P/0029/2020.info:eu-repo/semantics/publishedVersio

Estresse em pacientes com diabetes tipo 2

Este artigo objetiva apresentar uma revisão sobre a relação entre o Estresse e Diabetes do tipo 2. Foi realizada uma revisão de literatura narrativa na base de dados da biblioteca Virtual em Saúde por artigos publicados entre os anos de 2003 e 2013, utilizando os descritores “estresse e diabetes tipo 2” e suas combinações. Os achados desta revisão reforçam que há relação entre estresse e diabetes Os sintomas do estresse mais citados foram os psicológicos, sendo que a predominância do estresse foi maior nas mulheres que nos homens. Foi possível inferir que as mulheres com estresse elevado apresentaram controle glicêmico alterado. A maioria relatou sofrimento decorrente de problemas nas relações interpessoais, óbito, doença de familiares e solidão. Os resultados ainda sugerem que outros fatores, além dos emocionais, devem ser considerados na análise da adesão ao tratamento do diabetes. Houve maior proporção de trabalhadores diabéticos com sobrepeso, hipertensão arterial e glicemia capilar alterada, quando comparados aos que não tinham essa doença, ficando evidente que pacientes com doenças crônicas têm maior probabilidade de desenvolver formas patológicas de estresse, ansiedade e depressão, podendo apresentar ainda dificuldades no manejo da doença comprometendo a adesão ao tratamento e consequentemente sua qualidade de vida. Nossos resultados mostram a relação do estresse como fator associado à portadora de DM e a necessidade de medidas que incluam o controle de estresse ao tratamento preconizado para esta doença, com a finalidade de melhorar os níveis glicêmicos e prevenir o aparecimento de complicações

The long-term evolution of the Douro River as evidenced by strath terrace staircases located at NE Portugal (western Iberia)

In western Iberia, mechanisms that explain the transition from endorheic to exorheic continental-scale drainage reorganisation are foreland basin overspill, headwards erosion and capture by an Atlantic river, or a combination of both. To explore these controls we have investigated the Portuguese sector of the Douro River, the site of drainage re-organsation. The Douro River routes downstream through weak sedimentary infill of the Douro Cenozoic Basin (Spain), after which the river cuts down through granitic and metamorphic rocks cut by active fault zones (NE Portugal), before reaching the Atlantic coast. We investigated the drainage reorganisation using an integrated remote sensing, field survey and geochronological approach applied to Pliocene-Quaternary fluvial sediments and landforms. The older drainage record is documented by a series of high and intermediate landform levels comprising 1) a high level (1000-600 m) faulted regional fluvial erosion surface, the North Iberian Meseta Planation Surface (NIMPS); 2) an inset level (650-600 m altitude) comprising a broad fluvial surface formed onto a large ENE-WSW depression that overlies resistant ProterozoicandPaleozoic bedrock and 3) an inset (500450m) fluvial surface. The younger drainage record comprises an entrenched fluvial strath terrace sequence of up to 9 levels (T9 = oldest positioned at 246-242 m above the modern river base (a.r.b); T1 = youngest positioned at 17-13 m a.r.b.). Levels T1 and T3 display fault offsets where the cross active NNE-SSW fault zones. The three lowest terrace levels (T1-T3) were dated using optically stimulated luminescence (OSL) techniques using Quartz-OSL and post infra-red stimulated luminescence (pIRIR). Results ranged from 39-12ka (T1), 57ka (T2) and >360ka (minimum) (T3). Fluvial incision rates of the younger (terrace) drainage record were quantified and temporally exptrapolated to model the ages of the high to intermediate elevation levels of the early drainage record. Integration of incision data with fault zone derived crustal uplift values informs on the timing of the endorheic to exhoreic drainage reorganization. We interpret the NIMPS to be part of the endorehic Douro Cenozoic Basin drainage divide erosion. The inset wide fluvial surface at 650-600 m altitude represents the overspill level in the area of the Mesão Frio ridges (drainage divide with the Atlantic drainage). Development of the exhoreic ancestral Douro valley is documented in the 500-450 m fluvial surface with our age and uplift modelling suggesting this became established during the upper Pleistocene (3.6 Ma) through to the Early Pleistocene (1.8 Ma). The entrenched river terrace sequence spans the Pleistocene, developing via spatial and temporal variations in rock strength, uplift and cyclic cool climate variability as the river adjusts to the Atlantic base level

Pyruvate Dehydrogenase Complex Deficiency: Updating the Clinical, Metabolic and Mutational Landscapes in a Cohort of Portuguese Patients

Background: The pyruvate dehydrogenase complex (PDC) catalyzes the irreversible decarboxylation of pyruvate into acetyl-CoA. PDC deficiency can be caused by alterations in any of the genes encoding its several subunits. The resulting phenotype, though very heterogeneous, mainly affects the central nervous system. The aim of this study is to describe and discuss the clinical, biochemical and genotypic information from thirteen PDC deficient patients, thus seeking to establish possible genotype-phenotype correlations. Results: The mutational spectrum showed that seven patients carry mutations in the PDHA1 gene encoding the E1α subunit, five patients carry mutations in the PDHX gene encoding the E3 binding protein, and the remaining patient carries mutations in the DLD gene encoding the E3 subunit. These data corroborate earlier reports describing PDHA1 mutations as the predominant cause of PDC deficiency but also reveal a notable prevalence of PDHX mutations among Portuguese patients, most of them carrying what seems to be a private mutation (p.R284X). The biochemical analyses revealed high lactate and pyruvate plasma levels whereas the lactate/pyruvate ratio was below 16; enzymatic activities, when compared to control values, indicated to be independent from the genotype and ranged from 8.5% to 30%, the latter being considered a cut-off value for primary PDC deficiency. Concerning the clinical features, all patients displayed psychomotor retardation/developmental delay, the severity of which seems to correlate with the type and localization of the mutation carried by the patient. The therapeutic options essentially include the administration of a ketogenic diet and supplementation with thiamine, although arginine aspartate intake revealed to be beneficial in some patients. Moreover, in silico analysis of the missense mutations present in this PDC deficient population allowed to envisage the molecular mechanism underlying these pathogenic variants. Conclusion: The identification of the disease-causing mutations, together with the functional and structural characterization of the mutant protein variants, allow to obtain an insight on the severity of the clinical phenotype and the selection of the most appropriate therapy.info:eu-repo/semantics/publishedVersio

Desenvolvimento da competência cultural na formação dos estudantes de enfermagem

The aim was to identify and map the strategies for the development of cultural competence during the training of students in nursing education institutions. For the elaboration of this Integrative Literature Review, the PCC method was used to develop the research question: What are the strategies used by Nursing Education Institutions to develop cultural competence during the training of students? To answer the question asked, a search was carried out, using the EBSCO-host and PubMed search engines, and the respective databases Cumulative Index to Nursing and Allied Health Literature and MedLine. No time horizon limits were applied. The established languages ​​were Portuguese, English and Spanish. For the assessment of methodological quality, we used a critical assessment instrument, specific for each type of study (qualitative and quantitative). Seven studies were included in the selection, which after being analyzed showed that there are strategies through which students can develop CC, but the most used are: Mobility Programs and Cultural Competence Courses. These results provide evidence of the potential use of educational strategies for the development of CC in nursing students.Objetivou-se identificar e mapear as estratégias de desenvolvimento da competência cultural durante a formação dos estudantes nas instituições de ensino de enfermagem. Para a elaboração da presente Revisão Integrativa da Literatura, recorreu-se ao método PCC, de forma a desenvolver a questão de investigação: Quais são as estratégias utilizadas pelas Instituições de Ensino de Enfermagem para Desenvolvimento da competência cultural durante a formação dos estudantes? De modo a dar resposta à questão formulada, realizou-se uma pesquisa, com recurso aos motores de busca EBSCO-host e PubMed, e às respectivas bases de dados Cumulative Index to Nursing and Allied Health Literature e MedLine. Não foram aplicados limites de horizonte temporal. Os idiomas estabelecidos foram, português, inglês e espanhol. Para a avaliação da qualidade metodológica, utilizamos um instrumento de avaliação crítica, específico para cada tipo de estudo (qualitativo e quantitativo). Sete estudos foram incluídos na seleção, que após analisados demonstraram que há estratégias através das quais os estudantes podem desenvolver CC, porém as mais utilizadas são: os Programas de Mobilidade e os Cursos de Competência Cultural. Estes resultados fornecem evidências do potencial da utilização das estratégias educativas relativamente ao desenvolvimento da CC nos estudantes de Enfermagem