Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms.

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

Convolutional Neural Networks in the Inspection of Serrasalmids (Characiformes) Fingerlings.

Aquaculture produces more than 122 million tons of fish globally. Among the several economically important species are the Serrasalmidae, which are valued for their nutritional and sensory characteristics. To meet the growing demand, there is a need for automation and accuracy of processes, at a lower cost. Convolutional neural networks (CNNs) are a viable alternative for automation, reducing human intervention, work time, errors, and production costs. Therefore, the objective of this work is to evaluate the efficacy of convolutional neural networks (CNNs) in counting round fish fingerlings (Serrasalmidae) at different densities using 390 color photographs in an illuminated environment. The photographs were submitted to two convolutional neural networks for object detection: one model was adapted from a pre-trained CNN and the other was an online platform based on AutoML. The metrics used for performance evaluation were precision (P), recall (R), accuracy (A), and F1-Score. In conclusion, convolutional neural networks (CNNs) are effective tools for detecting and counting fish. The pre-trained CNN demonstrated outstanding performance in identifying fish fingerlings, achieving accuracy, precision, and recall rates of 99% or higher, regardless of fish density. On the other hand, the AutoML exhibited reduced accuracy and recall rates as the number of fish increased.

Pericarditis Due to Campylobacter fetus subsp. fetus: A Case Report of an Uncommon Infection.

Pericarditis is a common condition with numerous aetiologies. Bacteria other than the Mycobacterium tuberculosis complex are an exceptional cause. We present a case of subacute pericarditis highly probable due to Campylobacter fetus subsp. fetus in an immunosuppressed patient undergoing biologic therapy in relation to systemic lupus erythematosus (SLE). On admission, the patient presented with chest pain, dyspnea, and diaphoresis and has lately developed fever and a large pericardial effusion (PE) with a concomitant increase in the inflammatory parameters. The clinical presentation, along with the exclusion of a flare of the autoimmune disease and the isolation of Campylobacter fetus subsp. fetus on blood samples permitted the diagnosis. After therapy with antibiotics and colchicine, the patient showed full recovery.

Validation of the Comprehensive Feeding Practices Questionnaire (CFPQ) with Portuguese Caregivers of 2-to-8-Year-Olds.

Recent findings have demonstrated an increase in the prevalence of childhood obesity and overweight in Portugal, urging the need to study modifiable risk factors such as parental feeding practices. The Comprehensive Feeding Practices Questionnaire (CFPQ) is an important self-report measure assessing a broad range of responsive and non-responsive feeding practices. However, the CFPQ has not yet been validated in Portugal. Therefore, the present study aimed to test the validity of this measure with Portuguese parents of 2-to-8-year-old children. A sample of 409 parents completed a Portuguese-adapted version of the CFPQ and the already validated Child Feeding Questionnaire (CFQ). Confirmatory factor analysis (CFA), exploratory factor analysis (EFA), and psychometric analysis were conducted. CFA demonstrated the original 12-factor structure did not fit the sample. EFA identified an eight-factor structure comprising 29 items: Monitoring, Modeling, Environment, Involvement, Emotion Regulation, Restriction for Weight Control, Restriction for Health, and Pressure. Findings suggest that parental feeding practices are sensitive to parents' background cultures and children's developmental period.

Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper.

Inappropriate polypharmacy is highly prevalent among older adults and presents a significant healthcare concern. Conducting medication reviews and implementing deprescribing strategies in multimorbid older adults with polypharmacy are an inherently complex and challenging task. Recognizing this, the Special Interest Group on Pharmacology of the European Geriatric Medicine Society has compiled evidence on medication review and deprescribing in older adults and has formulated recommendations to enhance appropriate prescribing practices. The current evidence supports the need for a comprehensive and widespread transformation in education, guidelines, research, advocacy, and policy to improve the management of polypharmacy in older individuals. Furthermore, incorporating deprescribing as a routine aspect of care for the ageing population is crucial. We emphasize the importance of involving geriatricians and experts in geriatric pharmacology in driving, and actively participating in this transformative process. By doing so, we can work towards achieving optimal medication use and enhancing the well-being of older adults in the generations to come.

Complementary Feeding Methods: Associations with Feeding and Emotional Responsiveness.

Learning to eat complementary foods is a crucial milestone for infants, having implications across development. The most used method for introducing complementary foods is Traditional Spoon-Feeding (TSF). However, the alternative method Baby-Led Weaning (BLW) is increasingly becoming used as it has been associated with positive outcomes. Research analyzing associations between complementary feeding methods and responsive parenting is practically non-existent. Therefore, the objective of this study was to analyze differences in emotional and feeding responsiveness between caregivers who previously implemented traditional vs. non-traditional feeding approaches. Caregivers (mostly mothers) of 179 children between 3 and 5 years were asked about the complementary feeding method that they had followed previously (70.4% reported using the TSF, 16.8% said they used the BLW and 12.8% used both methods simultaneously). In addition, they reported on their feeding practices using the Comprehensive Feeding Practices Questionnaire and on their responses to children's distress using the Coping with Children's Negative Emotions Scale. The results showed that parents who reported using a non-traditional (BLW or both) complementary feeding method reported less pressure to eat and minimization of reactions to children's negative emotions, compared to parents who used a traditional method (although these reported using more problem-focused reactions). The findings suggest that complementary feeding methods and responsive parenting may be linked, leaving the question of which one sets the stage for the other.

Deprescribing practices, habits and attitudes of geriatricians and geriatricians-in-training across Europe: a large web-based survey.

PURPOSE: To provide an overview of the current deprescribing attitudes, practices, and approaches of geriatricians and geriatricians-in-training across Europe. METHODS: An online survey was disseminated among European geriatricians and geriatricians-in-training. The survey comprised Likert scale and multiple-choice questions on deprescribing approaches and practices, deprescribing education and knowledge, and facilitators/barriers of deprescribing. Responses to the survey questions and participant characteristics were quantified and differences evaluated between geriatricians and geriatricians-in-training and between European regions. RESULTS: The 964 respondents (median age 42 years old; 64% female; 21% geriatricians-in-training) were generally willing to deprescribe (98%) and felt confident about deprescribing (85%). Despite differences across European regions, the most commonly reported reasons for deprescribing were functional impairment and occurrence of adverse drug reactions. The most important barriers for deprescribing were patients' unwillingness, fear of negative consequences, lack of time, and poor communication between multiple prescribers. Perceived risk of adverse drug reactions was highest for psychotropic drugs, nonsteroidal anti-inflammatory drugs, cardiovascular drugs, and opioid analgesics. Only one in four respondents (23% of geriatricians and 37% of geriatricians-in-training) think education in medical school had sufficiently prepared them for deprescribing in clinical practice. They reported that their future deprescribing activities would probably increase with improved information sharing between various prescribers, deprescribing recommendations in guidelines, and increased education and training. Approximately 90% think that a paradigm shift is required for prescribers and patients, increasing focus on the possible benefits of deprescribing (potentially) inappropriate medications. CONCLUSIONS: Based on the outcomes of this survey, we recommend investing in improved inter-professional communication, better education and evidence-based recommendations to improve future patient-centered deprescribing practices.

Associations between Emotion Regulation, Feeding Practices, and Preschoolers' Food Consumption.

Previous research identified emotion dysregulation, non-responsive feeding practices, and unhealthy food consumption as risk factors for childhood obesity. However, little is known about the relationships between these factors. This study examined associations between children's emotion regulation, parental feeding practices, and children's food consumption. The sample consisted of 163 mothers of children aged 3-5 years. Mothers completed the Emotion Regulation Checklist, the Child Feeding Questionnaire, and the Child Health Section from the Parent Interview of the Early Childhood Longitudinal Study-B to assess model variables. Results showed that healthy food consumption was associated with higher emotion regulation abilities, higher monitoring, and lower pressure to eat. For unhealthy food consumption, the associations were in opposite directions. Higher emotion regulation abilities were also associated with higher monitoring, lower pressure to eat, and lower restriction. For lability, the associations were in opposite directions. Regression analyses revealed that children's lability, pressure to eat, and monitoring were significant predictors of children's food consumption. These findings suggest that children's emotion regulation and feeding practices are important determinants of children's food consumption. Future longitudinal studies that examine bidirectional associations between children's emotion regulation, parental feeding practices, children's food consumption, and potential mechanisms accounting for these associations are needed.

A Systematic Review of the Current Evidence from Randomised Controlled Trials on the Impact of Medication Optimisation or Pharmacological Interventions on Quantitative Measures of Cognitive Function in Geriatric Patients.

BACKGROUND: Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people's cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults. METHODS: A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score. RESULTS: Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7). CONCLUSION: This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients.

Caregivers' Responses to Children's Negative Emotions: Associations with Preschoolers' Executive Functioning.

There is a lack of knowledge regarding the connection between parental emotional responsiveness and children's executive functioning (EF). This study aimed to explore the relations between caregivers' reactions to their children's distress and children's EF. Mothers of 136 preschoolers reported their reactions to their children's negative emotions using the Coping with Children's Negative Emotions Scale. Children's EF was assessed through the mothers and teachers' reports using the Behavioral Inventory of Executive Functioning for Preschool Children. Results showed that the mothers' perceived use of negative emotional regulation responses (i.e., punitive and minimizing reactions) was associated with lower levels of EF in children, as reported by both mothers and teachers. The association between the mothers' use of positive emotional regulation responses (i.e., problem-focused, emotion-focused, and expressive encouragement reactions) and children's EF was not significant. Multiple regression analyses revealed that the mothers' use of negative emotional regulation responses accounted for significant proportions of variance in EF indexes. These findings suggest that parental socialization of emotion could be important for children's EF. Specifically, caregivers' negative emotional regulation responses to children's distress may serve as a risk factor for poorer EF in children. Efforts to improve children's EF may be more effective when parental emotional responsiveness to their distress is considered.

Attachment and the Development of Prosocial Behavior in Children and Adolescents: A Systematic Review.

(1) Background: One key assumption of attachment theory is the relationship between security and the development of prosocial behavior. A secure child is more likely to feel and show concern for another individual, resulting in higher levels of prosocial behaviors (defined as voluntary behavior intended to benefit others-e.g., helping, sharing, comforting). (2) Method: Using a systematic review of the literature (PROSPERO: CRD42022290706), 703 articles were identified (EBSCO databases), from which 16 were considered eligible by the first two authors (inter-reviewer agreement: 85.714%). The criteria for an article's exclusion were as follows: samples of children/teens not living in natural contexts; studies on psychopathologies; intervention programs; qualitative designs; studies on development or the validation of measures; studies that did not reliably measure the variables studied. (3) Results and Discussion: The eligible studies revealed incongruous results about the potential associations between attachment security to mothers and fathers and prosocial behavior. More consistent and significant relationships were found between the quality of attachment and empathy, while the associations between attachment and prosocial behavior were inconsistent (e.g., nine articles revealed significant associations; seven did not). In six studies, empathy was revealed to play an important role as the mediator between attachment security and prosocial behavior. The limitations and future recommendations were discussed.

Better off alone? Comparing the substance use, mental health and trauma risks of youth alcohol and other drug service users either living in out of home care, living with parents or experiencing homelessness.

INTRODUCTION: All young people seeking assistance from youth alcohol and other drug services require support to help them minimise the harms from their substance use and continue to develop healthy and meaningful lives. A particular focus on young people in residential out of home care (OoHC) highlights the increased risks of substance use, mental health issues and continued vulnerabilities in this group. While in the past, research contrasted this group with young people living at home, this study contrasted young people in OoHC with homeless youths alongside those living with parents. METHODS: The research contrasted these three groups of young people on substance use profiles, mental health and wellbeing and vulnerability to abuse (historic and current) in the Youth Needs Census conducted in Victoria and Queensland over 2013-2017. RESULTS: The results demonstrate a clear risk of increased casual and daily methamphetamine use in the homeless youth group and occasional heroin use in the OoHC group. Mental health measures for both the OoHC and homeless youths were worse than the young people living at home. Trauma was similarly higher in these groups, with both historical and ongoing risks of violent crime for homeless youths. DISCUSSION AND CONCLUSIONS: The results demonstrate the similar and serious health and wellbeing risks facing both youths in residential OoHC and homeless youths. These results are concerning as one of these groups is ostensibly in the care of the community and government, while the other group is experiencing unstable accommodation and associated physical risks.

Attachment and the Development of Moral Emotions in Children and Adolescents: A Systematic Review.

In recent years, the development of social and moral emotions (often associated to pro-social behaviors) has become the subject of increased research interest. However, the relation between these emotions and attachment is less studied. The present systematic literature review (PROSPERO: CRD42021247210) was designed to synthesize current empirical contributions that explore the link between attachment and the development of moral emotions (e.g., empathy, sympathy, altruism, and guilt) during childhood and adolescence. Article exclusion criteria included: studies with participants not living in natural contexts (e.g., institutionalized); studies on mental illness; qualitative research; research that does not reliably evaluate attachment or moral emotions; research on intervention programs; and non-peer-reviewed articles. Only 10 studies were found eligible. Results highlight a present focus on empathy and guilt and gaps regarding sympathy and altruism. The mediator role and positive effect of emotion regulation was noted. Significant positive correlations between attachment security and guilt, shame and forgiveness were emphasized. Limitations of the eligible studies included: representativeness of the participants; causality of the results; and the validity and significance of the instruments (e.g., lack of results reported by various parties involved). The present review aims to contribute to the understanding of an empathic, healthy development, in contrast to the alienation and bullying affecting the youth's emotional, relational and academic lives.

Early Attachment to Mothers and Fathers: Contributions to Preschoolers' Emotional Regulation.

Children acquire and develop emotional regulatory skills in the context of parent-child attachment relationships, nonetheless empirical studies have focused mainly on mother and less information is available regarding the role of both parent-child attachment relationships. Furthermore, despite its importance, there is no information regarding preschool years. This study aims to fill this gap by exploring the potential influences of both mother-child and father-child attachments on preschooler's later emotion regulation observed in the peer group. Fifty-three Portuguese nuclear families (mother, father and focal child) participated in the study; 47% of the children were boys and 53% were girls. Attachment Security was assessed at home using the Attachment Behavior Q-set when children were 3 years of age, and emotion regulation was observed in the preschool classrooms attended by the children at age 5, using the California child Q-sort to derive an Emotion Regulation Q-Scale. Results showed that the combined influence of both parent-child attachment security predicted better emotion regulation results, than did the specific contributions of each parent per se. Findings are consistent with integrative approaches that highlight the value of including both mother- and father-child attachment relationships, as well as their combined effect, when studying emotion regulation.

Educational technology for bathing/hygiene of elders at home: contributions to career knowledge.

OBJECTIVE: to build and validate an educational booklet for bathing and hygiene of elders at home. METHODS: a methodological study, developed through data collection in literature and situational diagnosis, booklet construction, material qualification through validation by expert judges (11 nurses) and target audience (30 caregivers). Data were analyzed descriptively. The minimum content validity index of 0.80 was considered. RESULTS: in content and appearance validation, experts assigned Content Validity Index global of 0.92, while for assessment of the material's suitability, the booklet was classified as "superior", with an average of 90%. In the validation of caregivers, the overall Content Validity Index was 1.0. CONCLUSION: the booklet was successfully validated and can be considered in the context of health education and collaborate with an adequate and safe practice of bathing and hygiene of elders at home.

Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications.

PURPOSE: In the pathogenesis of severe COVID-19 complications, derangements of renin-angiotensin-aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. METHODS: We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. RESULTS: Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. CONCLUSIONS: Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.

Caregivers' Perceived Emotional and Feeding Responsiveness toward Preschool Children: Associations and Paths of Influence.

Although there is a large body of research connecting emotion to eating behaviors, little is known about the role of caregivers' responses to children's emotions in the context of child feeding. The purpose of this study was to analyze the relation between caregivers' emotional responsiveness and feeding responsiveness. The mothers of 137 children between 2 and 6 years of age reported on their responses to children's negative emotions using the Coping with Children's Negative Emotions Scale and on their feeding practices using the Comprehensive Feeding Practices Questionnaire. The results showed that mothers' supportive emotion responses (e.g., problem-focused, emotion-focused, and expressive encouragement reactions) tend to be positively associated with responsive feeding practices (e.g., encouraging, modelling, and teaching healthy food-related behaviors). Instead, mothers' unsupportive responses (e.g., distress, punitive and minimization reactions) tend to be positively associated with nonresponsive feeding practices (e.g., food as reward or to regulate emotions, and pressure to eat) and negatively associated with responsive feeding practices. Our results suggest that emotional and feeding responsiveness may be intertwined and that differences in parent's emotional responsiveness may translate into differences in their feeding styles, setting the stage for parents' use of positive vs. negative feeding practices.

Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials.

BACKGROUND: Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty. METHODS: A literature search was performed in Medline to detect prospective randomized controlled trials (RCTs) testing the effects of pharmacological interventions or medication optimization in older frail adults on comprehensive frailty scores or partial aspects of frailty that were published from January 1998 to October 2019. RESULTS: Twenty-five studies were identified, 4 on comprehensive frailty scores and 21 on aspects of frailty. Two trials on comprehensive frailty scores showed positive results on frailty although the contribution of medication review in a multidimensional approach was unclear. In the studies on aspects related to frailty, ten individual drug interventions showed improvement in physical performance, muscle strength or body composition utilizing alfacalcidol, teriparatide, piroxicam, testosterone, recombinant human chorionic gonadotropin, or capromorelin. There were no studies examining negative effects of drugs on frailty. CONCLUSION: So far, data on a causal relationship between drugs and frailty are inconclusive or related to single-drug interventions on partial aspects of frailty. There is a clear need for RCTs on this topic that should be based on a comprehensive, internationally consistent and thus reproducible concept of frailty assessment.

Measurement invariance across mother/child and father/child attachment relationships.

We examine the factorial structure of the Security Scale Questionnaire (SSQ), exploring measurement invariance across mother-father-child attachment relationships, child sex, and country. We used the new 21-item SSQ version that integrates both safe haven and secure base behaviors in a two factors structure. Participants were 457 children (224 girls and 233 boys), ranging from 9 to 14 years old (M = 10.84, SD = 1.02) from Portuguese and USA samples. We confirmed the SSQ's two-factor structure, although four items were unrelated to the latent structure and excluded from the final model. Results showed that SSQ can be used to study both mother/child and father/child attachment relationships. Multi-group analyses suggested measurement invariance between boys and girls and between Portuguese and USA samples. Our findings suggest that the SSQ can be considered a valid and cost-effective tool to measure perceived attachment security in middle childhood for both mother/child and father/child relationships.