Raw meat-based diet for pets: a neglected source of human exposure to Salmonella and pathogenic Escherichia coli clones carrying mcr, Portugal, September 2019 to January 2020.

BackgroundThe pet industry is expanding worldwide, particularly raw meat-based diets (RMBDs). There are concerns regarding the safety of RMBDs, especially their potential to spread clinically relevant antibiotic-resistant bacteria or zoonotic pathogens.AimWe aimed to investigate whether dog food, including RMBD, commercially available in Portugal can be a source of Salmonella and/or other Enterobacteriaceae strains resistant to last-line antibiotics such as colistin.MethodsFifty-five samples from 25 brands (21 international ones) of various dog food types from 12 suppliers were screened by standard cultural methods between September 2019 and January 2020. Isolates were characterised by phenotypic and genotypic methods, including whole genome sequencing and comparative genomics.ResultsOnly RMBD batches were contaminated, with 10 of 14 containing polyclonal multidrug-resistant (MDR) Escherichia coli and one MDR Salmonella. One turkey-based sample contained MDR Salmonella serotype 1,4,[5],12:i:- ST34/cgST142761 with similarity to human clinical isolates occurring worldwide. This Salmonella exhibited typical antibiotic resistance (bla TEM + strA-strB + sul2 + tet(B)) and metal tolerance profiles (pco + sil + ars) associated with the European epidemic clone. Two samples (turkey/veal) carried globally dispersed MDR E. coli (ST3997-complexST10/cgST95899 and ST297/cgST138377) with colistin resistance (minimum inhibitory concentration: 4 mg/L) and mcr-1 gene on IncX4 plasmids, which were identical to other IncX4 circulating worldwide.ConclusionSome RMBDs from European brands available in Portugal can be a vehicle for clinically relevant MDR Salmonella and pathogenic E. coli clones carrying genes encoding resistance to the last-line antibiotic colistin. Proactive actions within the One Health context, spanning regulatory, pet-food industry and consumer levels, are needed to mitigate these public health risks.

Decoding Klebsiella pneumoniae in poultry chain: unveiling genetic landscape, antibiotic resistance, and biocide tolerance in non-clinical reservoirs.

The rise of antibiotic resistance in the food chain is influenced by the use of antimicrobial agents, such as antibiotics, metals, and biocides, throughout the entire farm-to-fork continuum. Besides, non-clinical reservoirs potentially contribute to the transmission of critical pathogens such as multidrug-resistant (MDR) Klebsiella pneumoniae. However, limited knowledge exists about the population structure and genomic diversity of K. pneumoniae circulating in conventional poultry production. We conducted a comprehensive characterization of K. pneumoniae across the whole chicken production chain (7 farms; 14 flocks + environment + meat, 56 samples; 2019-2022), exploring factors beyond antibiotics, like copper and quaternary ammonium compounds (QACs). Clonal diversity and adaptive features of K. pneumoniae were characterized through cultural, molecular (FT-IR), and whole-genome-sequencing (WGS) approaches. All except one flock were positive for K. pneumoniae with a significant increase (p < 0.05) from early (n = 1/14) to pre-slaughter (n = 11/14) stages, most (n = 6/7) persisting in chicken meat batches. Colistin-resistant K. pneumoniae rates were low (4%-n = 1/24 positive samples), while most samples carried MDR strains (67%-n = 16/24) and copper-tolerant isolates (63%-n = 15/24, with sil and pco gene clusters; MICCuSO4 ≥ 16 mM), particularly at pre-slaughter. Benzalkonium chloride consistently exhibited activity against K. pneumoniae (MIC/MBC range = 4-64 mg/L) from representative strains independently of the presence or absence of genes linked to QACs tolerance. A polyclonal K. pneumoniae population, discriminated by FT-IR and WGS, included various lineages dispersed throughout the chicken's lifecycle at the farm (ST29-KL124, ST11-KL106, ST15-KL19, ST1228-KL38), until the meat (ST1-KL19, ST11-KL111, ST6405-KL109, and ST6406-CG147-KL111), or over years (ST631-49 KL109, ST6651-KL107, ST6406-CG147-KL111). Notably, some lineages were identical to those from human clinical isolates. WGS also revealed F-type multireplicon plasmids carrying sil + pco (copper) co-located with qacEΔ1 ± qacF (QACs) and antibiotic resistance genes like those disseminated in humans. In conclusion, chicken farms and their derived meat are significant reservoirs for diverse K. pneumoniae clones enriched in antibiotic resistance and metal tolerance genes, some exhibiting genetic similarities with human clinical strains. Further research is imperative to unravel the factors influencing K. pneumoniae persistence and dissemination within poultry production, contributing to improved food safety risk management. This study underscores the significance of understanding the interplay between antimicrobial control strategies and non-clinical sources to effectively address the spread of antimicrobial resistance.

Unveiling a Listeria monocytogenes Outbreak in a Rabbit Farm: Clinical Manifestation, Antimicrobial Resistance, Genomic Insights and Environmental Investigation.

Listeria monocytogenes poses a threat to both human and animal health. This work describes an L. monocytogenes outbreak in a Portuguese rabbit farm, detailing the isolates' clinical manifestations, necropsy findings, and phenotypic and genomic profiles. Clinical signs, exclusively observed in does, included lethargy and reproductive signs. Post-mortem examination of does revealed splenomegaly, hepatomegaly with a reticular pattern, pulmonary congestion, and haemorrhagic lesions in the uterus, with thickening of the uterine wall and purulent greyish exudates. Positive L. monocytogenes samples were identified in fattening and maternity units across different samples, encompassing does and environmental samples. Core-genome Multi Locus Sequence Typing (cgMLST) analysis confirmed the outbreak, with the 16 sequenced isolates (lineage II, CC31, and ST325) clustering within a ≤2 allelic difference (AD) threshold. Antimicrobial susceptibility testing for five antibiotics revealed that 15 out of 19 outbreak isolates were resistant to sulfamethoxazole-trimethoprim (SXT). Concordantly, all SXT-resistant sequenced isolates were found to exclusively harbour a plasmid containing a trimethoprim-resistance gene (dfrD), along with loci linked to resistance to lincosamides (lnuG), macrolides (mphB), and polyether ionophores (NarAB operon). All sequenced outbreak isolates carried the antibiotic resistance-related genes tetM, fosX, lin, norB, lmrB, sul, and mprF. The outbreak cluster comprises isolates from does and the environment, which underscores the ubiquitous presence of L. monocytogenes and emphasizes the importance of biosecurity measures. Despite limited data on listeriosis in rabbit farming, this outbreak reveals its significant impact on animal welfare and production.

Emotional Management Strategies in Prehospital Nurses: A Scoping Review.

BACKGROUND: Prehospital care is intricate and unpredictable. Nurses in this environment encounter psychologically challenging situations and traumatic experiences daily. Nurses respond variably when delivering care in this context. This study aims to map the emotional management strategies used by prehospital nurses. METHODS: Research was conducted in MEDLINE, CINAHL Complete, and the Open Access Scientific Repository of Portugal (RCAAP). The inclusion criteria were studies with prehospital nurses in Portuguese, English, and Spanish languages, covering all study types. RESULTS: From the initial 511 studies identified, four studies were deemed eligible after rigorous screening. The strategies used are individual (pre- and post-event) and collective, varying from formal to informal, with or without institutional support. Notable experiences included a lack of technical/scientific preparation, personal life association, treating acquaintances, pediatric-age patients, childbirth, cardiopulmonary arrests in young individuals, traffic accidents, and suicides. CONCLUSIONS: Nurses need training in basic emotional management tools. This research provides an initial understanding of their emotional well-being's impact on personal and professional performance. This study was prospectively registered with the Open Science Framework (OSF) on 29 June 2023, with the registration number: z638t.

Desenvolvimento de Competências Especializadas e Estratégias de Gestão Emocional dos Enfermeiros no Pré-hospitalar / Development of Specialized Competencies and Emotional Management Strategies for Pre-hospital Nurses

O presente documento enquadra-se no Curso de Mestrado em Enfermagem Médico-Cirúrgica da Escola Superior de Enfermagem de Coimbra e remete-nos para o estágio desenvolvido em contexto pré-hospitalar. Este encontra-se dividido em duas partes. Na primeira parte, evidencia-se o desenvolvimento de competências através de uma metodologia descritiva, analítica e critico-reflexiva sobre as atividades desenvolvidas, as experiências vivenciadas, e as dificuldades sentidas neste percurso, partindo-se das competências comuns do enfermeiro especialista e das específicas do enfermeiro especialista em Enfermagem Médico-Cirúrgica na área de Enfermagem à pessoa em situação crítica. Releva-se a promoção do raciocínio crítico, o incremento dos conhecimentos e o fortalecimento de um suporte efetivo para a tomada de decisão fundamentada. Na segunda parte, é realizada uma investigação secundária do tipo scoping review, apresentada sob a forma de artigo científico e onde se procurou dar resposta às questões de revisão: Quais as estratégias de gestão emocional utilizadas pelo enfermeiro no pré-hospitalar? Quais as características das estratégias de gestão emocional que são adotadas pelos enfermeiros no pré-hospitalar? Quais as experiências que induzem à utilização de estratégias de gestão emocional nos enfermeiros que trabalham em contexto pré-hospitalar?. O objetivo foi mapear as estratégias de gestão emocional utilizadas pelo enfermeiro no pré-hospitalar. Tornou-se claro que é urgente dotar os enfermeiros não só de competências cognitivas e profissionais, mas também emocionais. Aliadas às competências técnicas e científicas, os enfermeiros devem ser munidos e formados em ?ferramentas? básicas de inteligência e gestão emocional. As instituições de saúde devem fomentar e promover a implementação das estratégias identificadas, como as conversas informais e o debriefing. Os cuidados de enfermagem de excelência, prestados por enfermeiros competentes em todas as dimensões, refletem-se em ganhos em saúde para a pessoa e família, equipa e instituição.

From Farm to Fork: Persistence of Clinically Relevant Multidrug-Resistant and Copper-Tolerant Klebsiella pneumoniae Long after Colistin Withdrawal in Poultry Production.

Concerns about colistin-resistant bacteria in animal food-environmental-human ecosystems prompted the poultry sector to implement colistin restrictions and explore alternative trace metals/copper feed supplementation. The impact of these strategies on the selection and persistence of colistin-resistant Klebsiella pneumoniae in the whole poultry production chain needs clarification. We assessed colistin-resistant and copper-tolerant K. pneumoniae occurrence in chickens raised with inorganic and organic copper formulas from 1-day-old chicks to meat (7 farms from 2019 to 2020), after long-term colistin withdrawal (>2 years). Clonal diversity and K. pneumoniae adaptive features were characterized by cultural, molecular, and whole-genome-sequencing (WGS) approaches. Most chicken flocks (75%) carried K. pneumoniae at early and preslaughter stages, with a significant decrease (P < 0.05) in meat batches (17%) and sporadic water/feed contamination. High rates (>50%) of colistin-resistant/mcr-negative K. pneumoniae were observed among fecal samples, independently of feed. Most samples carried multidrug-resistant (90%) and copper-tolerant (81%; silA and pcoD positive and with a MICCuSO4 of ≥16 mM) isolates. WGS revealed accumulation of colistin resistance-associated mutations and F type multireplicon plasmids carrying antibiotic resistance and metal/copper tolerance genes. The K. pneumoniae population was polyclonal, with various lineages dispersed throughout poultry production. ST15-KL19, ST15-KL146, and ST392-KL27 and IncF plasmids were similar to those from global human clinical isolates, suggesting chicken production as a reservoir/source of clinically relevant K. pneumoniae lineages and genes with potential risk to humans through food and/or environmental exposure. Despite the limited mcr spread due to the long-term colistin ban, this action was ineffective in controlling colistin-resistant/mcr-negative K. pneumoniae, regardless of feed. This study provides crucial insights into the persistence of clinically relevant K. pneumoniae in the poultry production chain and highlights the need for continued surveillance and proactive food safety actions within a One Health perspective. IMPORTANCE The spread of bacteria resistant to last-resort antibiotics such as colistin throughout the food chain is a serious concern for public health. The poultry sector has responded by restricting colistin use and exploring alternative trace metals/copper feed supplements. However, it is unclear how and to which extent these changes impact the selection and persistence of clinically relevant Klebsiella pneumoniae throughout the poultry chain. We found a high occurrence of copper-tolerant and colistin-resistant/mcr-negative K. pneumoniae in chicken flocks, regardless of inorganic and organic copper formulas use and a long-term colistin ban. Despite the high K. pneumoniae isolate diversity, the occurrence of identical lineages and plasmids across samples and/or clinical isolates suggests poultry as a potential source of human K. pneumoniae exposure. This study highlights the need for continued surveillance and proactive farm-to-fork actions to mitigate the risks to public health, relevant for stakeholders involved in the food industry and policymakers tasked with regulating food safety.

Occurrence of Multidrug-Resistant Bacteria Resulting from the Selective Pressure of Antibiotics: A Comprehensive Analysis of ESBL K. pneumoniae and MRSP Isolated in a Dog with Rhinorrhea.

Because of public health concerns, much greater scrutiny is now placed on antibiotic use in pets, especially for antimicrobial agents that have human analogs. Therefore, this study aimed to characterize the phenotypic and genotypic profiles of multidrug-resistant bacteria isolated from nasal swabs samples taken from a one-year-old male Serra da Estrela dog with rhinorrhea that was treated with amikacin. An extended-spectrum ß-lactamases (ESBL) Klebsiella pneumoniae was isolated in the first sample taken from the left nasal cavity of the dog. Seven days later, methicillin-resistant (MRSP) Staphylococcus pseudintermedius was also isolated. Nevertheless, no alterations to the therapeutic protocol were performed. Once the inhibitory action of the antibiotic disappeared, the competitive advantage of the amikacin-resistant MRSP was lost, and only commensal flora was observed on both nasal cavities. The genotypic profile of extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae revealed the same characteristics and close relation to other strains, mainly from Estonia, Slovakia and Romania. Regarding MRSP isolates, although resistance to aminoglycosides was present in the first MRSP, the second isolate carried aac(6')-aph(2″), which enhanced its resistance to amikacin. However, the veterinary action was focused on the treatment of the primary agent (ESBL K. pneumoniae), and the antibiotic applied was according to its phenotypic profile, which may have led to the resolution of the infectious process. Therefore, this study highlights the importance of targeted therapy, proper clinical practice and laboratory-hospital communication to safeguard animal, human and environmental health.

Gulls in Porto Coastline as Reservoirs for Salmonella spp.: Findings from 2008 and 2023.

Gulls act as intermediaries in the exchange of microorganisms between the environment and human settlements, including Salmonella spp. This study assessed the antimicrobial resistance and molecular profiles of Salmonella spp. isolates obtained from fecal samples of gulls in the city of Porto, Portugal, in 2008 and 2023 and from water samples in 2023. Antimicrobial susceptibility profiling revealed an improvement in the prevalence (71% to 17%) and antimicrobial resistance between the two collection dates. Two isolate collections from both 2008 and 2023 underwent serotyping and whole-genome sequencing, revealing genotypic changes, including an increased frequency in the monophasic variant of S. Typhimurium. qacE was identified in 2008 and 2023 in both water and fecal samples, with most isolates exhibiting an MDR profile. The most frequently observed plasmid types were IncF in 2008 (23%), while IncQ1 predominated in 2023 (43%). Findings suggest that Salmonella spp. circulate between humans, animals, and the environment. However, the genetic heterogeneity among the isolates from the gulls' feces and the surface water may indicate a complex ecological and evolutionary dynamic shaped by changing conditions. The observed improvements are likely due to measures to reduce biological contamination and antimicrobial resistance. Nevertheless, additional strategies must be implemented to reduce the public health risk modeled by the dissemination of pathogens by gulls.

Is There Still Time to Orthodontics in Elderly Patients? / Ainda há Tempo para a Ortodontia na Melhor Idade?

Life expectancy rate has increased in the past decades and a crescent number of elderly patients are searching for dental treatment aiming for aesthetic and functional rehabilitation. Geriatric Dentistry is a dental specialty which focuses on the elderly population dental care, specially aiming at preventive and healing care of patients with diseases or systemic and chronic conditions, associated to physiological, physical or psychological deficiencies. Other specialties in Dentistry, such as Orthodontics, have become important allies in this new challenge of the Dental profession. This study aimed at analyzing characteristics involved in orthodontic treatment when associated with gerontologic needs, considering relevant factors to an adequate application based on a case report. The treatment was planned integrating Periodontics, Orthodontics, Prosthodontics and Operative Dentistry practice, allowing the reestablishment of function and aesthetics harmonically. Orthodontic treatment represents a feasible procedure in Geriatric Dentistry, as long as applying light forces and respecting both the characteristics and limitations of these areas of treatment.(AU)

Com o aumento considerável da expectativa de vida da população, um crescente número de pacientes idosos tem procurado tratamento odontológico para reabilitação estética e/ou funcional. A Odontogeriatria, é a especialidade odontológica que enfatiza o cuidado bucal da população idosa, especificamente do atendimento preventivo e curativo de pacientes com doenças ou condições de caráter sistêmico e crônico, associadas a problemas fisiológicos, físicos ou psicológicos. Diversas especialidades odontológicas, dentre elas a Ortodontia, vêm se integrando com esta área odontológica. Este trabalho objetiva abordar as características do tratamento ortodôntico associado a uma atuação odontogeriátrica, considerando os fatores relevantes para a execução do tratamento ortodôntico nesses pacientes a partir do relato de um caso clínico. Planejou-se este caso de forma integrada, envolvendo Periodontia, Ortodontia, Prótese e Dentística Restauradora, que foram capazes de devolver à paciente função e estética. O tratamento ortodôntico representa uma intervenção viável na atuação odontogeriátrica, desde que realizado com forças suaves, considerando as limitações e respeitando as características inerentes a esta atuação. (AU)

High diversity of pathogenic Escherichia coli clones carrying mcr-1 among gulls underlines the need for strategies at the environment-livestock-human interface.

The expansion of mcr-carrying bacteria is a well-recognized public health problem. Measures to contain mcr spread have mainly been focused on the food-animal production sector. Nevertheless, the spread of MCR producers at the environmental interface particularly driven by the increasing population of gulls in coastal cities has been less explored. Occurrence of mcr-carrying Escherichia coli in gull's colonies faeces on a Portuguese beach was screened over 7 months. Cultural, molecular and genomic approaches were used to characterize their diversity, mcr plasmids and adaptive features. Multidrug-resistant mcr-1-carrying E. coli were detected for 3 consecutive months. Over time, multiple strains were recovered, including zoonotic-related pathogenic E. coli clones (e.g. B2-ST131-H22, A-ST10 and B1-ST162). Diverse mcr-1 genetic environments were mainly associated with ST2/ST4-HI2 (ST10, ST131, ST162, ST354 and ST4204) but also IncI2 (ST12990) plasmids or in the chromosome (ST656). Whole-genome sequencing revealed enrichment of these strains on antibiotic resistance, virulence and metal tolerance genes. Our results underscore gulls as important spreaders of high-priority bacteria and genes that may affect the environment, food-animals and/or humans, potentially undermining One-Health strategies to reduce colistin resistance.

Nonlinear mixed models for characterization of growth trajectory of New Zealand rabbits raised in tropical climate.

OBJECTIVE: The identification of nonlinear mixed models that describe the growth trajectory of New Zealand rabbits was performed based on weight records and carcass measures obtained using ultrasonography. METHODS: Phenotypic records of body weight (BW) and loin eye area (LEA) were collected from 66 animals raised in a didactic-productive module of cuniculture located in the southern Piauí state, Brazil. The following nonlinear models were tested considering fixed parameters: Brody, Gompertz, Logistic, Richards, Meloun 1, modified Michaelis-Menten, Santana, and von Bertalanffy. The coefficient of determination (R2), mean squared error, percentage of convergence of each model (%C), mean absolute deviation of residuals, Akaike information criterion (AIC), and Bayesian information criterion (BIC) were used to determine the best model. The model that best described the growth trajectory for each trait was also used under the context of mixed models, considering two parameters that admit biological interpretation (A and k) with random effects. RESULTS: The von Bertalanffy model was the best fitting model for BW according to the highest value of R2 (0.98) and lowest values of AIC (6,675.30) and BIC (6,691.90). For LEA, the Logistic model was the most appropriate due to the results of R2 (0.52), AIC (783.90), and BIC (798.40) obtained using this model. The absolute growth rates estimated using the von Bertalanffy and Logistic models for BW and LEA were 21.51g/d and 3.16 cm2, respectively. The relative growth rates at the inflection point were 0.028 for BW (von Bertalanffy) and 0.014 for LEA (Logistic). CONCLUSION: The von Bertalanffy and Logistic models with random effect at the asymptotic weight are recommended for analysis of ponderal and carcass growth trajectories in New Zealand rabbits. The inclusion of random effects in the asymptotic weight and maturity rate improves the quality of fit in comparison to fixed models.

Is relative fat mass a better indicator of high blood pressure levels when compared to other anthropometric indexes? / ¿Es la masa grasa relativa un mejor indicador de los niveles de presión arterial alta en comparación con otros índices antropométricos?

Background: relative fat mass (RFM) has been proposed recently, and the effectiveness in relation to other anthropometric indexes already consolidated regarding the predictive capacity of high blood pressure levels (HBPL) has not been investigated yet. Objectives: the objective was to analyze the predictive capacity of RFM for HBPL, and to compare it with others indexes. Methods: a cross-sectional study was conducted with 896 individuals. Weight, height, hip, waist circunference (WC), and neck circunference measurements were evaluated, and RFM, body mass index (BMI), body adiposity index, waist/hip ratio, and waist/height ratio were calculated. Systolic (SBP) and diastolic (DBP) blood pressures were measured on one occasion. Descriptive statistics, Pearson's correlation, a logistic regression model, and the analysis of the receiver operating characteristic (ROC) curves were used. Results: HBPL proportion was higher in men (34.68 %, p < 0.01). There was a positive correlation (p < 0.01) between all anthropometric measurements and SBP and DBP. WC in males (OR, 3.66; p < 0.01) and BMI in females (OR, 5.06; p < 0.01) showed the greatest associations with HBPL. There was no statistical difference (p > 0.05) in the area under the curve. Conclusions: the findings of our study suggest that RFM is not the best index for predicting HBPL, although it has shown positive associations. (AU)

Introducción: se ha propuesto recientemente la medida de la masa grasa relativa (RFM) como predictor de la hipertensión arterial (HBPL), aunque su valor predictivo y la comparación con otros índices antropométricos está por evaluar. Objetivos: el objetivo fue analizar la capacidad predictiva de la RFM para el HBPL y compararlo con otros índices. Métodos:se realizó un estudio transversal con 896 individuos. Se evaluaron las medidas de peso, talla, cadera, circunferencia de la cadera (CC) y circunferencia del cuello, y se calcularon la RFM, el índice de masa corporal (IMC), el índice de adiposidad corporal, la relación cintura/cadera y la relación cintura/estatura. En una ocasión se midió la presión arterial sistólica (PAS) y diastólica (PAD); se utilizaron la estadística descriptiva, la correlación de Pearson, un modelo de regresión logística y el análisis de las curvas Receiver Operating Characteristic (ROC). Resultados: la proporción de HBPL fue mayor en los hombres (34,68 %; p < 0,01). Hubo una correlación positiva (p < 0.01) entre todas las medidas antropométricas y PAS y PAD. La CC en los hombres (OR: 3,66; p < 0,01) y el IMC en las mujeres (OR: 5,06; p < 0,01) mostraron las mayores asociaciones con los HBPL. No hubo diferencia estadística (p > 0.05) en el área bajo la curva. Conclusiones: los hallazgos de nuestro estudio sugieren que la RFM no es el mejor índice para predecir el HBPL, aunque ha mostrado asociaciones positivas. (AU)

The Influence of the Affinity between Aggregate and Bitumen on the Mechanical Performance Properties of Asphalt Mixtures.

Two of the main problems encountered in flexible pavements are the stripping of coarse aggregates and the formation of rut depth due to increases in the volume of road traffic and heavy vehicle loads, especially in areas where speeds are low. The existence of rut depth also affects the comfort and safety of road users due to the water accumulation on the pavement surface and reducing tire/pavement friction, which can lead to hydroplaning phenomena. In this research, it was proven that the use of fillers of different origins influences the affinity between aggregates and the binder. The effect of an adhesion promoter in the mix design (such as the amine included in cellulosic fiber pellets) was also studied. Several tests were carried out to determine the binder/aggregate adhesiveness, water sensitivity and resistance to permanent deformation, to evaluate the performance of different blends. It was found that the addition of this additive increased 10% of the aggregate surfaces covered with bitumen when compared with the aggregates without this addition. As expected, the water sensitivity tests showed that the mixture with granitic filler had the lowest indirect tensile strength ratio (ITSR) value (70%), while the mixtures with limestone filler led to the highest percentages (ranging from 83 to 93%). As for the results of the wheel tracking tests (WTT), it was confirmed that the use of limestone filler translates into an improvement in the performance against the permanent deformation of the asphalt mixtures. The mixture with higher bitumen content and adhesion promoter revealed the best average results.

Is relative fat mass a better indicator of high blood pressure levels when compared to other anthropometric indexes?

INTRODUCTION: Background: relative fat mass (RFM) has been proposed recently, and the effectiveness in relation to other anthropometric indexes already consolidated regarding the predictive capacity of high blood pressure levels (HBPL) has not been investigated yet. Objectives: the objective was to analyze the predictive capacity of RFM for HBPL, and to compare it with others indexes. Methods: a cross-sectional study was conducted with 896 individuals. Weight, height, hip, waist circunference (WC), and neck circunference measurements were evaluated, and RFM, body mass index (BMI), body adiposity index, waist/hip ratio, and waist/height ratio were calculated. Systolic (SBP) and diastolic (DBP) blood pressures were measured on one occasion. Descriptive statistics, Pearson's correlation, a logistic regression model, and the analysis of the receiver operating characteristic (ROC) curves were used. Results: HBPL proportion was higher in men (34.68 %, p < 0.01). There was a positive correlation (p < 0.01) between all anthropometric measurements and SBP and DBP. WC in males (OR, 3.66; p < 0.01) and BMI in females (OR, 5.06; p < 0.01) showed the greatest associations with HBPL. There was no statistical difference (p > 0.05) in the area under the curve. Conclusions: the findings of our study suggest that RFM is not the best index for predicting HBPL, although it has shown positive associations.

INTRODUCCIÓN: Introducción: se ha propuesto recientemente la medida de la masa grasa relativa (RFM) como predictor de la hipertensión arterial (HBPL), aunque su valor predictivo y la comparación con otros índices antropométricos está por evaluar. Objetivos: el objetivo fue analizar la capacidad predictiva de la RFM para el HBPL y compararlo con otros índices. Métodos: se realizó un estudio transversal con 896 individuos. Se evaluaron las medidas de peso, talla, cadera, circunferencia de la cadera (CC) y circunferencia del cuello, y se calcularon la RFM, el índice de masa corporal (IMC), el índice de adiposidad corporal, la relación cintura/cadera y la relación cintura/estatura. En una ocasión se midió la presión arterial sistólica (PAS) y diastólica (PAD); se utilizaron la estadística descriptiva, la correlación de Pearson, un modelo de regresión logística y el análisis de las curvas Receiver Operating Characteristic (ROC). Resultados: la proporción de HBPL fue mayor en los hombres (34,68 %; p < 0,01). Hubo una correlación positiva (p < 0.01) entre todas las medidas antropométricas y PAS y PAD. La CC en los hombres (OR: 3,66; p < 0,01) y el IMC en las mujeres (OR: 5,06; p < 0,01) mostraron las mayores asociaciones con los HBPL. No hubo diferencia estadística (p > 0.05) en el área bajo la curva. Conclusiones: los hallazgos de nuestro estudio sugieren que la RFM no es el mejor índice para predecir el HBPL, aunque ha mostrado asociaciones positivas.

Adesão dos Utentes face ao rastreio do cancro colorretal / User adherence to colorectal cancer screening

O cancro colorretal é uma das principais causas de morte relacionadas com cancro, com incidência especialmente elevada em países desenvolvidos sendo a implementação de programas de rastreio essencial na diminuição da mortalidade. Em Portugal, nos últimos anos, a incidência do cancro colorretal tem aumentado significativamente, mas sabe-se que o mesmo pode ser prevenido e tratado. A literatura consultada dá-nos conta que a população não assume atitudes positivas em relação ao método de rastreio e não apresenta conhecimentos suficientes sobre este problema, tão importante de saúde pública. De facto, o cancro colorretal é uma das neoplasias malignas mais suscetíveis de ser evitada através da prevenção primária e do seu rastreio. Sobressaem as funções do enfermeiro especialista em enfermagem comunitária e as suas competências para dar resposta aos diferentes desafios na saúde que as comunidades enfrentam. Assim, neste estudo objetivou-se avaliar a adesão dos utentes ao rastreio do cancro colorretal, ao realizarem a colonoscopia e a PSOF, avaliando os conhecimentos, atitudes, comportamentos e a informação relativa ao cancro colorretal dos utentes de uma Unidade de Saúde Familiar da região centro, para assim desenvolver estratégias que visem a diminuição das barreiras à adesão ao rastreio do cancro colorretal. Para isso, caracterizaram-se as condições sociodemográficas; o estado de saúde dos utentes; identificou-se o nível de conhecimento sobre os fatores de risco e rastreio; analisaram-se as atitudes desses utentes sobre a prevenção e diagnóstico precoce do cancro colorretal e a informação sobre o seu comportamento, bem como as fontes de informação disponíveis. Realizou-se um estudo transversal, descritivo e de carater quantitativo, numa amostra não probabilística por conveniência de 425 inquiridos numa Unidade de Saúde Familiar da região centro, apresentando uma média de idades entre os 50 e 74 anos, sendo 55,5% do sexo feminino. Para obtenção dos dados recorreu-se à aplicação de um questionário concebido no estudo Knowledge, attitudes, and preventive practices about colorectal cancer among adults in na área of Southern Italy, testado para a população portuguesa por Forno (2009). Os dados obtidos foram analisados através do Statistical Program for Social Sciences (SPSS) versão 24 de 2016. Cerca de 47,1% não demonstraram conhecimento dos exames de rastreio, mas a maioria tinha conhecimento de pelo menos um dos principais exames de rastreio (Pesquisa de sangue oculto nas fezes e Colonoscopia). 50,4% apresentaram uma atitude positiva moderada em relação à realização de exames de rastreio, tendo sido atribuído um especial destaque à utilidade dos exames de rastreio do cancro colorretal. A esta postura associou-se o facto de terem conhecimento da definição do cancro colorretal (94,8%) e obterem informação através dos enfermeiros e da comunicação social. Os resultados desta investigação apontam para a necessidade de implementação de estratégias que visem o aumento da adesão ao rastreio do cancro colorretal (realização da colonoscopia e PSOF), diminuindo assim a morbimortalidade, sendo essencial a articulação entre os vários profissionais de saúde, para assim conduzir à obtenção de ganhos em saúde.

Colorectal Cancer is one of the main related causes of death with cancer, with incidence particularly raised in developed countries, with the implementation of programmes of essential tracing in the decrease of mortality. In Portugal, in recent years, the incidence of colorectal cancer has increased significantly, however it is known that it can be prevented and treated. According to the literature reviewed and analysed, the results revealed that the population does not take positive attitudes towards the screening method and it is not aware of this crucial problem of public health. In fact, the colorectal cancer is one of malignant neoplasia more likely to be prevented by primary prevention and screening. It enlightens the strategic positioning of the Specialist Nurse in Community Nursing and his/her skills to give responses to the different health challenges faced by communities. Consequently, this study aimed to evaluate adherence of users to screening for colorectal cancer, assessing knowledge, attitudes, behaviors and relative information to CRC' s Family Health Unit in the central region in order to develop strategies intended to lessen barriers to the acceptance of colorectal cancer screening. For this purpose, the sociodemographic conditions, the patient's health status, the level of awareness about the risk factors and screening approaches were spotted and the patients' attitudes were analysed on the prevention and early diagnosis of the colorectal cancer. A cross-sectional, descriptive and quantitative character survey was held in a nonprobability sample by accordance of 425 respondents in a Family Health Unit in the central region, between the ages of 50 and 74 years, 55.5% female and 41.6% male. After obtaining permits and informed consent, a questionnaire was applied to study Knowledge, Attitudes and Preventive Practices about Colorectal cancer among adults in the southern regions of Italy tested for the Portuguese population by Forno (2009). The data obtained were analysed through the Statistical Program for Social Sciences (SPSS), version 24 of 2016. According to the results, 63.8% of respondents demonstrated having less insight of risk factors, which was significantly associated with age (the higher the age the lower the knowledge). Up to 47.1% did not demonstrate being conscious of the screening tests, meanwhile, the majority did and understand the importance of at least one major screening (Occult research in feces and Colonoscopy). 50.4% depicted a moderate positive attitude to screening exams having the usefulness of screening of the colorectal cancer been highly scored. This posture was associated with the fact that they had already known the definition of colorectal cancer (94.8%) and have obtained the information through the nurses and communication. The results of this research point out to the need for the application of strategies aimed at excelling the acceptance to colorectal cancer screening, thus decreasing the morbidity and mortality, it is essential the articulation between the various health professionals leading to health gains.

Anti-Candida and anti-Cryptococcus evaluation of 15 non-alkaloidal compounds from Pterogyne nitens

Objective: To evaluate anti-Candida and anti-Cryptococcus activities of 15 non-alkaloidal compounds from Pterogyne nitens Tulasne (Leguminosae), a South Amer-ican medicinal plant. Methods: Compounds were submitted to antifungal assays, using microdilution method described by Clinical and Laboratory Standards Institute document, with minor modifi-cations. Five species of Candida and two species of Cryptococcus, including clinical isolates were screened. Antifungal activity was expressed by minimum inhibitory con-centration (MIC). Amphotericin B and fluconazole were used as standard antifungal drugs. Results: Among tested compounds, six substances presented fungal growth inhibition (MIC Conclusions: Flavone derivatives from Pterogyne nitens can serve as prototypes for the design and development of innovative anti-Candida and anti-Cryptococcus hits.

Recursos artístico-expressivos na terapia familiar: um estudo teórico-clínico / Artistic and expressive features in family therapy: a theoretical and clinical study

Objetiva-se com este artigo discutir o emprego de recursos artístico-expressivos na terapia familiar. Organiza-se como um estudo teórico-clínico, pautado na metodologia qualitativa. Dessa forma, inicia-se com uma apresentação dos aspectos teóricos que fundamentam esse tipo de intervenção com o público em questão. Posteriormente, apresenta-se uma ilustração clínica de uma família acompanhada em um serviço-escola de Psicologia, cujo atendimento foi mediado pelos recursos artístico-expressivos. Finaliza-se apontando para o potencial da arteterapia em intervenções familiares, compreendendo-se que esta favorece não apenas a comunicação dosparticipantes como também a elaboração de questões concernentes ao grupo familiar. (AU)

This article aims to discuss the use of artistic and expressive resources in family therapy. It is organized as a theoretical-clinical study, based on qualitative methodology. Thus begins with a presentation of the theoretical aspects underlying this type of intervention with the public involved.Then, it presents a clinical illustration of a family accompanied in a psychological university service, whose treatment was mediated by artistic and expressive resources. Terminates, pointing to the potential of art therapy in family interventions, it being understood that it promotes not only the communication of the participants but also the elaboration of issues concerning the family group. (AU)

Desporto Adaptado em Portugal: do conceito à prática / Adapted Sport in Portugal: from concept to practice

O Desporto Adaptado representa, por um lado, um dos mais importantes fatores promotores do sucesso educativo, inclusão e desenvolvimento psicossocial, e por outro lado, o combate ao abandono escolar e discriminação das pessoas com deficiência. O objetivo deste estudo centra-se no aprofundamento de algumas questões subjacentes a esta temática a nível nacional, tais como: (1) a sua origem em Portugal; (2) as modalidades mais praticadas em Portugal, quer em contexto escolar quer federado; (3) a distribuição da amostra em função da idade, do género, do local de residência e do tipo de deficiência. Foram contactadas as instituições responsáveis pela gestão da prática desportiva a nível escolar e federado, bem como pela realização e divulgação periódica dos dados censatários da população. Os resultados apontam para uma reduzida taxa de envolvimento em atividades desportivas adaptadas em Portugal, assim como uma distribuição assimétrica desta população pelo território nacional. Os resultados obtidos preconizam a realização de estudos posteriores que aprofundem as relações de causa e efeito desta realidade, contribuindo para a delineação de estratégias que as suprimam na medida do possível.

The Adapted Sports is on the one hand, one of the most important factors that promote educational success, inclusion, and psychosocial development, and secondly, to combat school dropout and discrimination of people with disabilities. This study focuses on the deepening of some underlying issues at the national level, such as: (1) the origin in Portugal; (3 ) the most widely practiced sports in Portugal, either in schools or adulthood, (4) the distribution of the sample by age, gender, place of residence and type of disability. We contacted the institutions responsible for the management of sport at school level and adulthood, as well as the realization and dissemination of periodic statistic data of the population. The results point to a low rate of involvement in adapted sports activities in Portugal, as well as an asymmetric distribution of this population by the country. The results advocate the need of further studies to deepen the relations of cause and effect of this reality, contributing to devising strategies that suppress the extent possible.

Dispositivo de Dunn e de Chenet no tratamento do torcicolo congênito / Dunn and Chenet's devices in the treatment of congenital torticollis

O torcicolo congênito é caracterizado por fibrose e encurtamento do músculo esternocleidomastóideo. O diagnóstico é clínico e pode ser feito pela posição anômala da cabeça e presença de massa fibrosa fusiforme, pequena, indolor e dura à palpação, localizada na região central ou inferior do músculo afetado. O tratamento é fisioterápico, sendo a intervenção cirúrgica restrita aos casos que não respondem a fisioterapia. Se não tratado, pode levar a alterações permanentes na coluna e na musculatura ocular, além de assimetria facial, relacionada a subdesenvolvimento da mandíbula, com conseqüênte maloclusão. O objetivo do presente trabalho é enfatizar o papel do Odontopediatra no diagnóstico precoce e no tratamento multiprofissional da patologia, demonstrando, através de um caso clínico, os dispositivos de Dunn e de Chenet, que estimulam o desenvolvimento mandibular e são uma alternativa eficiente, segura, simples e prática para auxiliar no tratamento, reduzindo ou eliminado as seqüelas da patologia.

Schwannoma do seio maxilar: relato de caso / Schwannoma of maxillary sinus: a case report

Os autores relatam um caso de Schwannoma do seio maxilar e fazem uma pequena revisäo da literatura, abordando alguns aspectos conceituais, bem como a incidência, sintomatologia, dificuldades de diagnóstico, tratamento e prognóstico desta neoplasia