30 research outputs found

    Problemas de comportamento na adolescência: relação com a estrutura familiar e práticas educativas parentais

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    Dissertação de mestrado integrado em Psicologia (área de especialização em Psicologia da Justiça)Os problemas de comportamento assumem na adolescência uma expressão de relevo, especialmente no quadro da visão deficitária e negativa de que este período é objeto. Pesquisas nesta área procuram identificar os fatores de risco e de proteção, sendo que a família ou, mais especificamente, a estrutura familiar e as práticas educativas parentais, podem atuar em ambos os sentidos. A família assume assim, enquanto contexto social de referência, um papel determinante no desenvolvimento cognitivo e psicossocial dos seus elementos e mesmo na adolescência, em que filhos tendem a procurar uma maior autonomia e distanciamento dos pais, a qualidade desta relação assume grande relevância, estando associada a uma melhor adaptação social dos menores (Guimarães, Hochgraf, Brasiliano & Ingberman, 2009). Inerente à família, outro aspeto abordado é a estrutura familiar, no âmbito da qual as dimensões em análise no presente estudo, coesão e hierarquia, não tão amplamente investigadas, podem ajudar a explicar a manutenção ou aparecimento destes problemas. O presente estudo visa analisar, em 60 famílias - trinta das quais com adolescentes tendo processo de promoção e proteção instaurados, sinalizados por comportamentos desadequados, e outras trinta, cujos adolescentes não têm processo de promoção e proteção instaurado - de que forma a estrutura familiar e o comportamento parental se relacionam com os problemas de comportamento nos adolescentes, e averiguar se estes se diferenciam entre os grupos definidos. Para a prossecução deste objetivo, adotou-se uma metodologia de investigação quantitativa, constatando-se que existem diferentes associações entre a coesão e hierarquia ao nível de algumas das síndromas que fazem parte dos problemas de comportamento internalizante e externalizante. Assim, verifica- -se uma associação entre a coesão com a síndroma de queixas somáticas e comportamento agressivo. Quanto à hierarquia, existe uma associação com a síndroma do isolamento, comportamento delinquente e queixas somáticas. Nas práticas educativas inadequadas, constatou-se uma correlação negativa entre as práticas punitivas com a síndroma de isolamento e queixas somáticas; entre as práticas fisicamente abusivas com a síndroma de isolamento e comportamento delinquente; e entre as práticas inadequadas e emocionalmente abusivas com o comportamento delinquente. Relativamente às diferenças entre os grupos constituintes da amostra, as famílias com adolescentes sem processo de promoção e proteção relataram maiores níveis de coesão e de hierarquia, enquanto as famílias de adolescentes com processo de promoção e proteção instaurados relatam maior recurso às práticas punitivas, fisicamente abusivas e emocionalmente abusivas.Behavioral problems in adolescence assume an expression of relief, especially in the context of vision loss and negative that this period is the object. Research in this area seeks to identify the risk factors and protective, and the family, or more specifically, family structure and parenting practices, can work in both directions. The family assumes well as the social context of reference, a role in cognitive and psychosocial development of its elements and even in adolescence, when children tend to seek greater autonomy and distancing from parents, the quality of this relationship is of great importance, is associated with better social adjustment of children (Guimarães, Hochgraf, Brasiliano & Ingberman, 2009). Inherent to the family, another aspect addressed is the family structure, within which the dimensions in analysis the present study, cohesion and hierarchy, not as widely investigated of, may help explain the emergence or maintenance of these problems. This study aims to analyze, in 60 families - thirty of which are teenagers taking process initiated promotion and protection, indicated by inappropriate behavior, and other thirty, whose teenagers have no protection and promotion process in place - how the family structure and parental behavior related to behavior problems in adolescents, and to investigate whether these differ between groups defined. To achieve this goal, we adopted a methodology for quantitative research, noting that there are different relationships between cohesion and hierarchy to the level of some of the syndromes that are part of internalizing behavior problems and externalizing. Thus, there is an association between cohesion with the syndrome somatic complaints and aggressive behavior. As for the hierarchy, there is an association with the syndrome of isolation, delinquent behavior and somatic complaints. Inadequate educational practices, there was a negative correlation between the punitive practices with the syndrome of isolation and somatic complaints; practices among physically abusive with the syndrome of isolation and delinquent behavior; and inadequate practices and emotionally abusive to delinquent behavior. Regarding the differences between the constituents of the sample groups, families with teenagers without protection and promotion process reported higher levels of cohesion and hierarchy, while families of adolescents with process promotion and protection instituted report increased use of punitive practices, physically abusive and emotionally abusive

    As respostas humanas e diagnósticos de enfermagem em pessoas com cancro de cabeça e pescoço: revisão de literatura e síntese de evidência

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    Introduction: Head and neck cancer is relatively common with a high morbidity rate due to the anatomical sites that surround and may result in psychosocial, physical, or functional effects. Knowledge about the human responses and the corresponding nursing diagnoses of head and neck cancer patients undergoing surgery, as listed on NANDA-I, seems scarce.  Aim: Review the literature on knowledge about the human responses and the corresponding nursing diagnoses of head and neck cancer patients undergoing surgery. Materials and Methods: Integrative literature review with a search on electronic databases: CINALH®, MEDLINE®, Nursing & Allied Health®, and Scopus®. Results: A total of 31 papers were included in this review and 72 human responses, categorized in 29 diagnoses. Most diagnoses are subjective, and the most frequent nursing diagnosis was disturbed body image.  Conclusion: Identifying the most frequent human responses of these patients facilitates nurses in providing adequate care and in developing further research aiming to improve diagnoses accuracy. Most diagnoses are subjective, and the clinical validation could improve the level of evidence and provide nurses with clinical indicators for clinical reasoning and effective planning and interventions. Particularly, differential validation is needed in these patients as similar diagnoses and confounding clinical indicators have been identified. Further research is needed to evaluate the subjective nursing diagnoses considering the similarity and specific defining characteristics in head and neck cancer. Introdução: O cancro de cabeça e pescoço é relativamente comum com elevada taxa de morbidade, pelos locais anatômicos que o circundam podendo resultar em efeitos psicossociais, físicos ou funcionais. O conhecimento sobre as respostas humanas e os diagnósticos de enfermagem dos doentes com cancro de cabeça e pescoço submetidos a cirurgia, conforme listado na NANDA-I, parece escasso. Objetivo: Revisar a literatura quanto ao conhecimento sobre as respostas humanas e os diagnósticos de enfermagem dos doentes com cancro de cabeça e pescoço submetidos a cirurgia. Materiais e Métodos: Revisão integrativa da literatura, com pesquisa realizada nas bases de dados eletrónicas: CINALH®, MEDLINE®, Nursing & Allied Health® e Scopus®. Resultados: Um total de 31 artigos foram incluídos nesta revisão, identificadas 72 respostas humanas, categorizadas em 29 diagnósticos. A maioria dos diagnósticos é subjetiva, e o diagnóstico de enfermagem mais frequente foi distúrbio na imagem corporal. Conclusão: A identificação das respostas humanas mais frequentes nestes doentes facilita a prestação de cuidados adequados pelos enfermeiros e o desenvolvimento de novas pesquisas com o objetivo de melhorar a acurácia do diagnóstico. A maioria dos diagnósticos é subjetiva, a sua validação poderia melhorar o nível de evidência e fornecer aos enfermeiros indicadores clínicos de raciocínio clínico e planeamento de intervenções eficazes. Em particular, a validação diferencial é necessária nestes doentes, pois foram identificados diagnósticos similares e indicadores clínicos confusos. São necessárias mais pesquisas, para avaliar os diagnósticos de enfermagem subjetivos dos doentes com cancro de cabeça e pescoço, considerando a semelhança das suas características definidoras

    Diretriz Brasileira sobre a Saúde Cardiovascular no Climatério e na Menopausa – 2024

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    Women, who represent approximately half of the global population according to estimates as of January 2024, may experience signs and symptoms of menopause for at least one-third of their lives, during which they have a higher risk of cardiovascular morbidity and mortality. The effects of menopausal hormone therapy (MHT) on the progression of atherosclerosis and cardiovascular disease (CVD) events vary depending on the age at which MHT is initiated and the time since menopause until its initiation. Beneficial effects on CVD outcomes and all-cause mortality have been observed when MHT was initiated before the age of 60 or within 10 years after menopause. The decision regarding the initiation, dose, regimen, and duration of MHT should be made individually after discussing the benefits and risks with each patient. For primary prevention of postmenopausal chronic conditions, the combined use of estrogen and progestogen is not recommended in asymptomatic women, nor is the use of estrogen alone in hysterectomized women. Hormone-dependent neoplasms contraindicate MHT. For the treatment of genitourinary syndrome of menopause, vaginal estrogen therapy may be used in patients with known cardiovascular risk factors or established CVD. For women with contraindications to MHT or who refuse it, non-hormonal therapies with proven efficacy (antidepressants, gabapentin, and fezolinetant) may improve vasomotor symptoms. Compounded hormonal implants, or "bioidentical" and "compounded" hormones, and "hormone modulation" are not recommended due to lack of scientific evidence of their effectiveness and safety.Mujeres, que representan aproximadamente la mitad de la población mundial según estimaciones de enero de 2024, pueden experimentar signos y síntomas de la menopausia durante al menos un tercio de sus vidas, durante los cuales tienen un mayor riesgo de morbilidad y mortalidad cardiovascular. Los efectos de la terapia hormonal de la menopausia (THM) en la progresión de la aterosclerosis y los eventos de enfermedad cardiovascular (ECV) varían según la edad en que se inicia la THM y el tiempo transcurrido desde la menopausia hasta su inicio. Se han observado efectos beneficiosos en los resultados de ECV y la mortalidad por todas las causas cuando la THM se inició antes de los 60 años o dentro de los 10 años posteriores a la menopausia. La decisión sobre la iniciación, dosis, régimen y duración de la THM debe tomarse individualmente después de discutir los beneficios y riesgos con cada paciente. Para la prevención primaria de condiciones crónicas en la posmenopausia, no se recomienda el uso combinado de estrógeno y progestágeno en mujeres asintomáticas, ni el uso de estrógeno solo en mujeres histerectomizadas. Las neoplasias dependientes de hormonas contraindican la THM. Para el tratamiento del síndrome genitourinario de la menopausia, se puede usar terapia estrogénica vaginal en pacientes con factores de riesgo cardiovascular conocidos o ECV establecida. Para mujeres con contraindicaciones a la THM o que la rechazan, las terapias no hormonales con eficacia demostrada (antidepresivos, gabapentina y fezolinetant) pueden mejorar los síntomas vasomotores. Los implantes hormonales compuestos, o hormonas "bioidénticas" y "compuestas", y la "modulación hormonal" no se recomiendan debido a la falta de evidencia científica sobre su efectividad y seguridad.As mulheres, que representam cerca de metade da população mundial segundo estimativas de janeiro de 2024, podem sofrer com sinais e sintomas da menopausa durante pelo menos um terço de suas vidas, quando apresentam maiores risco e morbimortalidade cardiovasculares. Os efeitos da terapia hormonal da menopausa (THM) na progressão de eventos de aterosclerose e doença cardiovascular (DCV) variam de acordo com a idade em que a THM é iniciada e o tempo desde a menopausa até esse início. Efeitos benéficos nos resultados de DCV e na mortalidade por todas as causas ocorreram quando a THM foi iniciada antes dos 60 anos de idade ou nos 10 anos que se seguiram à menopausa. A decisão sobre o início, a dose, o regime e a duração da THM deve ser tomada individualmente após discussão sobre benefícios e riscos com cada paciente. Para a prevenção primária de condições crônicas na pós-menopausa, não se recomendam o uso combinado de estrogênio e progestagênio em mulheres assintomáticas nem o uso de estrogênio sozinho em mulheres histerectomizadas. Neoplasias hormônio-dependentes contraindicam a THM. Para tratamento da síndrome geniturinária da menopausa, pode-se utilizar terapia estrogênica por via vaginal em pacientes com fatores de risco cardiovascular conhecidos ou DCV estabelecida. Para mulheres com contraindicação à THM ou que a recusam, terapias não hormonais com eficácia comprovada (antidepressivos, gabapentina e fezolinetante) podem melhorar os sintomas vasomotores. Os implantes hormonais manipulados, ou hormônios “bioidênticos” “manipulados”, e a ‘modulação hormonal’ não são recomendados pela falta de evidência científica de sua eficácia e segurança

    The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

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    Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

    Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

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    The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

    TRY plant trait database – enhanced coverage and open access

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    Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

    Biofunctionalized liposomes to monitor rheumatoid arthritis regression stimulated by Interleukin-23 neutralization

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    Even after the revolution of rheumatoid arthritis (RA) treatment with biologic agents, this debilitating disease remains a major clinical problem. The outstanding outcomes of the systemic administration of antibodies (Abs) are narrowed by the risk of serious side effects and limited efficacy due to their short half-life. Interleukin-23 (IL-23) is a crucial pro-inflammatory cytokine involved in inflammation that potently enhances the generation of T-helper type-17 (Th17) cells. Hence, in this work, anti-IL-23 Abs are immobilized at the surface of liposomes to increase their therapeutic efficacy, being gold nanoparticles (AuNPs) incorporated to allow monitoring the biodistribution of the liposomes after systemic administration as well as due to their anti-inflammatory and antioxidant effects. A stable monodispersed liposomesâ suspension with around 130 nm is produced and efficiently biofunctionalized with anti-IL-23 Abs. IL-23 capture and neutralization capacity are confirmed using activated macrophages. Biological assays demonstrate their hemocompatibility and cytocompatibility with human articular chondrocytes, macrophages, and endothelial cells. Moreover, the neutralization of IL-23 by the biofunctionalized liposomes efficiently decreases the production of IL-17A by peripheral blood mononuclear cells of healthy donors and RA patients who are activated to Th17 differentiation. Therefore, the developed formulation may be a promising strategy to treat RA.The authors acknowledge the financial support from Portuguese Foundation for Science and Technology/Ministry of Science, Technology and Higher Education (FCT/MCTES) and the European Social Fund through the Operational Program of Human Capital (FSE/POCH), for the Ph.D. scholarship PD/BD/11384/2015 of A.C.L. (PD/59/2013), and the FCT for the contracts of A.C. (CEECIND/03628/2017) and C.C. (CEECIND/04601/2017). The authors would also like to acknowledge FCT for the project PTDC/BTM-SAL/28882/2017—Cells4_IDs, and the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) (NORTE-01-0145-FEDER-000023-FROnTHERA and NORTE-01-0145-FEDER-000013-PersonalizedNOS), and NORTE 2020 Structured Project within the R&D&I Structured Project, co funded by Norte2020—Programa Operacional Regional do Norte. The authors also acknowledge REMIX Project, funded by the European Union's Horizon 2020 Research and Innovation Programme under the Maria Sklodowska Curie Grant (Agreement No. 778078)
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