Consultas de enfermagem à distância em Portugal: recomendações de peritos

Background: the disruption caused by the pandemic COVID-19 in the access to health care was enormous. Many nurses used telephone consultation or other digital means (telenursing) to mitigate the impact on the population's health, but there are no recommendations for this practice. Objectives: to define recommendations to promote the development and standardization of the provision of telenursing care in Portugal. Methodology: project promoted by the      Portuguese Nurses Board, Centre Region     ). First, a quick literature review and a survey of needs and proposals were conducted through a survey to nurses and users. An Expert Panel (n=29) was then formed, mainly composed of nurses (referred by professional associations), but also by representatives of user associations, managers, among others. For each recommendation developed, the level of agreement was established (between 1 and 10) and it was adopted if approved by ≥75% of the experts. Results: consensus was reached on 4 general principles and 10 recommendations for conducting telenursing. The main concerns were the guarantee of safety, quality and individuality of care, which requires the adequacy of human, technical and training/organizational resources. Conclusion: these are the first recommendations for the provision of telenursing care, developed by nurses, users and other health stakeholders.Marco contextual: el trastorno causado por la pandemia COVID-19 en el acceso a la atención sanitaria fue enorme. Muchas enfermeras recurrieron a la consulta telefónica o a otros medio sdigitales (teleenfermería) para mitigar el impacto en la salud de las poblaciones, y no hay recomendaciones para esta práctica. Objetivos: definir recomendaciones para promover el desarrollo y la estandarización de la teleenfermería en Portugal. Metodología: en primer lugar, se realizó una rápida revisión de la literatura y una encuesta de las necesidades y propuestas a enfermeras y usuarios. A continuación, se formó un Panel de Expertos (n=29), compuesto principalmente por enfermeros, pero también por representantes de asociaciones de usuarios, gestores, entre otros. Para cada recomendación elaborada, se estableció el nivel de acuerdo (entre 1 y 10) y se adoptó si aprobada por ≥75% de los expertos. Resultados: se llegó a un consenso sobre 4 principios generales y 10 recomendaciones en teleenfermería. Las principales preocupaciones son la garantí     a de la seguridad, la calidad y la individualidad de los cuidados, que requieren la adecuación de los medios humanos, técnicos y formativos/organizativos. Conclusión: se trata de las primeras recomendaciones para la prestación de la teleenfermería, elaboradas por enfermeros, usuarios y otros agentes sanitários.Enquadramento: a disrupção causada pela pandemia COVID-19 no acesso aos cuidados de saúde foi enorme. Muitos enfermeiros recorreram à consulta telefónica ou a outros meios digitais (telenfermagem) para mitigar o impacto na saúde das populações, não existindo recomendações para esta prática. Objetivos: definir recomendações para promover o desenvolvimento e uniformização da prestação de cuidados de telenfermagem em Portugal. Metodologia: projeto promovido pela Secção Regional do Centro da Ordem dos Enfermeiros. Em primeiro lugar, realizou-se uma quickreview da literatura e um levantamento de necessidades e propostas através de um inquérito a enfermeiros e utentes. Formou-se então um Painel de Peritos (n=29) maioritariamente constituído por enfermeiros (referenciados por associações profissionais), mas também por representantes de associações de utentes, gestores, entre outros. Para cada recomendação desenvolvida foi estabelecido o nível de acordo (entre 1 e 10) e esta foi adotada se aprovada por ≥75% dos peritos. Resultados: consensualizaram-se 4 princípios gerais e 10 recomendações para a realização de telenfermagem. Denotam-se como principais preocupações o garante da segurança, qualidade, individualidade dos cuidados, o que requer a adequabilidade de meios humanos, técnicos e formativos/organizativos. Conclusão: estas são as primeiras recomendações para a prestação de telenfermagem, elaboradas por enfermeiros, utentes e outros stakeholders em saúde

Medida de Segurança: perfil dos internados em um hospital psiquiátrico do interior do Estado de São Paulo

Profile of Persons with Mental Disorders Authors of Crimes Insured in a Psychiatric Hospital of the Interior of São Paulo In the Brazilian criminal justice system, people who practice behaviors defined as crimes and have your understanding capacity of reality reduced due to mental disorders are classified as not imputable from punishment for which there is not worth it. Therefore, the individual is acquitted and submitted to the security measure, a measure of predominantly preventive character, which is based on the term dangerousness and not on the culpability of the agent. Within this context, this descriptive documentary research, which seeks, through the analysis of medical records, to understand who are the individuals hospitalized as a result of security measures in a public psychiatric hospital located in the Municipality of Ribeirão Preto. Among the results that have attracted attention are the prevalence, among the internees, of diagnoses of use of substances that cause addiction, the large number of disinternations without the performance of a report of dangerousness, as well as the predominance of individuals with low income and educational level. In this way the results point to the existence of problems that go beyond the knowledge produced by the health sciences or law, and the challenge of joining efforts among the different sectors in search of public policies that can guarantee that a more humanized assistance to people with mental disorders that have committed some kind of crime.No sistema de justiça criminal brasileiro, as pessoas que praticam condutas definidas como crimes e possuem sua capacidade de compreensão da realidade reduzida em decorrência de transtornos mentais são classificadas como inimputáveis, ou seja, para as quais não há pena. Logo, são absolvidas e submetidas à medida de segurança, esta de caráter predominantemente preventivo, fundamentada no termo ‘periculosidade’ e não ‘culpabilidade’ do agente. Nesse contexto, esta pesquisa documental descritiva busca, por meio da análise de prontuários médicos, descrever quem são os indivíduos internados em decorrência de medidas de segurança em um hospital psiquiátrico estadual localizado no Município de Ribeirão Preto/SP. Dentre os resultados, chamam atenção: a predominância, dentre os internados, de diagnósticos de utilização de substâncias que causam dependência; o grande número de desinternações sem que haja realização de laudo de periculosidade; bem como a predominância de indivíduos de baixa renda e grau de escolaridade. Os resultados apontam a existência de problemas que ultrapassam os conhecimentos produzidos isoladamente pelas ciências da saúde ou o direito, permanecendo o desafio de união de esforços entre diversos setores em busca de políticas públicas que possam garantir uma assistência mais humanizada às pessoas com transtornos mentais que praticaram algum tipo de delito

Identification of Candidate Genes for Reactivity in Guzerat (Bos indicus) Cattle: A Genome-Wide Association Study

[EN] Temperament is fundamental to animal production due to its direct influence on the animalherdsman relationship. When compared to calm animals, the aggressive, anxious or fearful ones exhibit less weight gain, lower reproductive efficiency, decreased milk production and higher herd maintenance costs, all of which contribute to reduced profits. However, temperament is a trait that is complex and difficult to assess. Recently, a new quantitative system, REATEST®, for assessing reactivity, a phenotype of temperament, was developed. Herein, we describe the results of a Genome-wide association study for reactivity, assessed using REATEST® with a sample of 754 females from five dual-purpose (milk and meat production) Guzerat (Bos indicus) herds. Genotyping was performed using a 50k SNP chip and a twostep mixed model approach (Grammar-Gamma) with a one-by-one marker regression was used to identify QTLs. QTLs for reactivity were identified on chromosomes BTA1, BTA5, BTA14, and BTA25. Five intronic and two intergenic markers were significantly associated with reactivity. POU1F1, DRD3, VWA3A, ZBTB20, EPHA6, SNRPF and NTN4 were identified as candidate genes. Previous QTL reports for temperament traits, covering areas surrounding the SNPs/genes identified here, further corroborate these associations. The seven genes identified in the present study explain 20.5% of reactivity variance and give a better understanding of temperament biology. IntroductionSIWe thank the farmers, who allowed the development of this project in their facilities. We thank to Mr. Peter Laspina for performing language review and for the valuable comments. This study was supported by Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and Empresa Brasileira de Pesquisa Agropecuária (Embrapa). Maria Gabriela Campolina Diniz Peixoto was supported by the Fapemig—CVZ APQ 01353 e CVZ APQ 3182–5.04/07. MRSC has a fellowship from the CNPq– 307975/2010-0 and was supported by CNPq– 312068/2015-8 and 481018/2008-5 projects. MGCDP, RVV, MAM have fellowships from FAPEMIG. PASF has CNPq fellowship, FCS and ICR have CAPES fellowships

Retelling the recent evolution of genetic diversity for Guzerá: Inferences from LD decay, runs of homozygosity and Ne over the generations

[EN] Genetic diversity is the one of the most important issues in conservation studies of livestock breeds or endangered species. In the present study, we tested the feasibility of describing the recent evolution in genetic diversity through genome-wide SNP genotyping and estimates of linkage disequilibrium decay patterns, effective population size, inbreeding coefficient based on runs of homozygosity and population structure. We choose the bovine indicine breed Guzerá because it has suffered recent bottlenecks which have been registered historically. A sample of 1036 females was genotyped using Illumina BovineSNP50. A resampling strategy was applied to correct for sampling biases caused by the population structure in herds, and by the extensive use of some sires for artificial reproduction. A subsample of 210 animals and 32,806 markers with MAF > 0.01 was used. Very low linkage disequilibrium was detected for distances greater than 120 Kb between two markers. Furthermore, three points of decrease in effective population size between generations were detected, which coincide with the historically registered bottlenecks. The inbreeding coefficient, based on runs of homozygosity, confirmed a strong contribution of the last 20–30 generations to current inbreeding. In the population structure analysis, the most probable number of sub-populations is 2, reflecting selection purpose (beef or dual-purpose). Taken together, these results allow a retelling of the recent evolution of this breed. The strategy described here will be useful for other breeds or even species for which a careful historical registry is not available for conservation proposals.SIWe thank to the farmers, who allowed the development of this project in their farms. We thank to Mr. Peter Laspina for reviewing language review and valuable comments. This study was supported by Fundação de Amparo a Pesquisa de Minas Gerais (FAPEMIG), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and Empresa Brasileira de Pesquisa Agropecuária (Embrapa). Marcos V. B. Silva was supported by the Embrapa – SEG 02.09.07.008.00.00 “Genomic Selection in Dairy Cattle in Brazil”, CNPq PVE 407246/2013-4 “Genomic Selection in Dairy Gyr and Girolando Breeds”, and FAPEMIG CVZ PPM 00395/14 “Genomic Selection in Brazilian Dairy Breeds” appropriated projects. MRSC has a fellowship from the CNPq – 307975/2010-0 and was supported by CNPq – 505338/2008-A and 481018/2008-5 projects. MGCDP, RVV, MAM have fellowships from FAPEMIG. PASF, FCS and ICR have CAPES fellowships

Uso de redes neurais artificais na predi??o de valores gen?ticos para peso aos 205 dias em bovinos da ra?a Tabapu?.

Dados de 19240 animais Tabapu?, provenientes de 152 fazendas localizadas em diversos estados brasileiros, nascidos entre 1976 e 1995, foram utilizados para predi??o do valor gen?tico do peso aos 205 dias de idade (VG_P205) por meio de redes neurais artificiais (RNAs) e usando o algoritmo LM ? Levenberg Marquardt ? para treinamento dos dados de entrada. Por se tratar de rede com aprendizado supervisionado, foram utilizados, como sa?da desejada, os valores gen?ticos preditos pelo BLUP para a caracter?stica P205. Os valores gen?ticos do P205 obtidos pela RNA e os preditos pelo BLUP foram altamente correlacionados. A ordena??o dos valores gen?ticos do P205 oriundos das RNAs e os valores preditos pelo BLUP (VG_P205_RNA) sugeriram que houve varia??o na classifica??o dos animais, indicando riscos no uso de RNAs para avalia??o gen?tica dessa caracter?stica. Inser??es de novos animais necessitam de novo treinamento dos dados, sempre dependentes do BLUP.Data from 19,240 Tabapu? animals from 152 farms located in different states of Brazil, born from 1976 to 1995, were used to predict the genetic value of body weight at 205 days of age (BV_P205) of Tabapu? beef cattle using Artificial Neural Networks (ANN) and LM algorithm - Levenberg Marquardt training for data entry. Due to the use of networks with supervised learning, the predicted breeding values for P205 from BLUP were used as desired output. The breeding values for P205 obtained from RNA and those predicted by BLUP were highly correlated. The ranked breeding values for body weight at 205 days through RNA and those predicted by BLUP (VG_P205_RNA) showed a variation in the classification of animals indicating risks in the use of ANNs procedure for genetic evaluation of this trait. Insertions of new animals require new training data always dependent on BLUP

Endocrine Dysfunction in Children with Zika-Related Microcephaly Who Were Born during the 2015 Epidemic in the State of Pernambuco, Brazil.

Congenital viral infections and the occurrence of septo-optic dysplasia, which is a combination of optic nerve hypoplasia, abnormal formation of structures along the midline of the brain, and pituitary hypofunction, support the biological plausibility of endocrine dysfunction in Zika-related microcephaly. In this case series we ascertained the presence and describe endocrine dysfunction in 30 children with severe Zika-related microcephaly from the MERG Pediatric Cohort, referred for endocrinological evaluation between February and August 2019. Of the 30 children, 97% had severe microcephaly. The average age at the endocrinological consultation was 41 months and 53% were female. The most frequently observed endocrine dysfunctions comprised short stature, hypothyroidism, obesity and variants early puberty. These dysfunctions occurred alone 57% or in combination 43%. We found optic nerve hypoplasia (6/21) and corpus callosum hypoplasia (20/21). Seizure crises were reported in 86% of the children. The most common-and clinically important-endocrine dysfunctions were pubertal dysfunctions, thyroid disease, growth impairment, and obesity. These dysfunctions require careful monitoring and signal the need for endocrinological evaluation in children with Zika-related microcephaly, in order to make early diagnoses and implement appropriate treatment when necessary

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

Zika-related adverse outcomes in a cohort of pregnant women with rash in Pernambuco, Brazil.

BACKGROUND: While Zika virus (ZIKV) is now widely recognized as a teratogen, the frequency and full spectrum of adverse outcomes of congenital ZIKV infection remains incompletely understood. METHODS: Participants in the MERG cohort of pregnant women with rash, recruited from the surveillance system from December/2015-June/2017. Exposure definition was based on a combination of longitudinal data from molecular, serologic (IgM and IgG3) and plaque reduction neutralization tests for ZIKV. Children were evaluated by a team of clinical specialists and by transfontanelle ultrasound and were classified as having microcephaly and/or other signs/symptoms consistent with congenital Zika syndrome (CZS). Risks of adverse outcomes were quantified according to the relative evidence of a ZIKV infection in pregnancy. FINDINGS: 376 women had confirmed and suspected exposure to ZIKV. Among evaluable children born to these mothers, 20% presented with an adverse outcome compatible with exposure to ZIKV during pregnancy. The absolute risk of microcephaly was 2.9% (11/376), of calcifications and/or ventriculomegaly was 7.2% (13/180), of additional neurologic alterations was 5.3% (13/245), of ophthalmologic abnormalities was 7% (15/214), and of dysphagia was 1.8% (4/226). Less than 1% of the children experienced abnormalities across all of the domains simultaneously. Interpretation: Although approximately one-fifth of children with confirmed and suspected exposure to ZIKV in pregnancy presented with at least one abnormality compatible with CZS, the manifestations presented more frequently in isolation than in combination. Due to the rare nature of some outcomes and the possibility of later manifestations, large scale individual participant data meta-analysis and the long-term evaluation of children are imperative to identify the full spectrum of this syndrome and to plan actions to reduce damages

The Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC): A Cohort Profile.

This cohort profile aims to describe the ongoing follow-up of children in the Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC). The profile details the context and aims of the study, study population, methodology including assessments, and key results and publications to date. The children that make up MERG-PC were born in Recife or within 120 km of the city, in Pernambuco/Brazil, the epicentre of the microcephaly epidemic. MERG-PC includes children from four groups recruited at different stages of the ZIKV microcephaly epidemic in Pernambuco, i.e., the Outpatient Group (OG/n = 195), the Microcephaly Case-Control Study (MCCS/n = 80), the MERG Pregnant Women Cohort (MERG-PWC/n = 336), and the Control Group (CG/n = 100). We developed a comprehensive array of clinical, laboratory, and imaging assessments that were undertaken by a 'task force' of clinical specialists in a single day at 3, 6, 12, 18 months of age, and annually from 24 months. Children from MCCS and CG had their baseline assessment at birth and children from the other groups, at the first evaluation by the task force. The baseline cohort includes 711 children born between February 2015 and February 2019. Children's characteristics at baseline, excluding CG, were as follows: 32.6% (184/565) had microcephaly, 47% (263/559) had at least one physical abnormality, 29.5% (160/543) had at least one neurological abnormality, and 46.2% (257/556) had at least one ophthalmological abnormality. This ongoing cohort has contributed to the understanding of the congenital Zika syndrome (CZS) spectrum. The cohort has provided descriptions of paediatric neurodevelopment and early epilepsy, including EEG patterns and treatment response, and information on the frequency and characteristics of oropharyngeal dysphagia; cryptorchidism and its surgical findings; endocrine dysfunction; and adenoid hypertrophy in children with Zika-related microcephaly. The study protocols and questionnaires were shared across Brazilian states to enable harmonization across the different studies investigating microcephaly and CZS, providing the opportunity for the Zika Brazilian Cohorts Consortium to be formed, uniting all the ZIKV clinical cohorts in Brazil