Programmes Addressed to Informal Caregivers' Needs: A Systematic Literature Review.

BACKGROUND: Addressing informal caregivers' needs is essential for ensuring quality healthcare and promoting citizen-centred care. This systematic review assessed current knowledge about programmes aimed at meeting the needs of informal caregivers of adults who are dependent on others for daily life activities. METHODS: Following the PRISMA guidelines, the electronic databases EBSCOhost Research Platform, MEDLINE, CINAHL, Scopus, Web of Science and The Virtual Health Library were searched for randomized experimental studies published between 2012 and 2022 that implemented programmes addressing informal caregivers' needs to improve their experiences, health, and well-being. Quality was assessed using the standardized critical evaluation tools from the Joanna Briggs Institute. Two independent investigators performed the eligibility assessment and data extraction. Quantitative data on the effectiveness of interventions were collected, and the content of each intervention was synthesized and aggregated into categories, through narrative synthesis. RESULTS: The majority of the included studies (n = 16) were conducted in European countries and implemented a structured intervention programme compared to the provision of usual care. The studies were of fair to high methodological quality, with a higher risk of bias related to blinding. The results supported the achievement of favourable health outcomes among informal caregivers, namely improvements in mental health (n = 3) and quality of life (n = 3) and a decrease in psychological symptomatology (n = 5) and burden (n = 3). None of the interventions reported adverse outcomes; however, five studies did not describe significant differences in the outcomes assessed after the implementation of the programmes. Interventions focusing on training and educating caregivers (n = 14) and cognitive-behavioural strategies (n = 7) were the most common, while programmes focusing on emotional and psychological support as a resource to improve caregivers' psychological outcomes were scarce. CONCLUSIONS: This systematic review adds to the growing body of evidence and insight showing that programmes that address informal caregivers' needs seem to contribute to better physical and psychological health outcomes through the promotion of caregivers' educational support and the implementation of cognitive-behavioural strategies. Future research should implement methodologically robust cross-country programmes tailored to informal caregivers' physical, emotional, psychosocial, societal, and educational needs throughout the care trajectory.

Transitional care for older persons with need of geriatric rehabilitation nursing interventions.

BACKGROUND: The literature review notes that people in need of care from Rehabilitation Programs do not always see their continuity ensured. OBJECTIVE: This study aim to analyze the perspective of Specialists Nurse in Rehabilitation Nursing in relation to the organization and specialized intervention of transitional care for older people in need of rehabilitation programs. METHODS: This is a qualitative study within the interpretivist paradigm. A focus group with 8 nurses and 13 interviews with Portuguese nurses were carried out between April 2022 and February 2023. Content analysis was carried out. RESULTS: The triangulation of the data made it possible to identify 3 categories: Coordination of a transitional care program; Empowering the person to self-manage the transitional care process and Empowering the Informal Caregiver. CONCLUSIONS: It is imperative to promote the coordination of transitional care, increase the functional capacity of the person and empower the informal caregiver.

Impact of family-centered care in families with children with intellectual disability: A systematic review.

Background: Family-Centered Care (FCC) is an approach to healthcare planning, delivery and evaluation, based on beneficial partnerships between health professionals, patients and families. FCC may be particularly relevant for families with children with intellectual disability (ID), given their needs of continuum care. Objective: To identify which components of the FCC are practiced and which health outcomes are considered effective in families with children with ID. Method: A systematic review guided by the PRISMA STATEMENT 2020 approach and the STROBE reporting guidelines was performed on specific databases through the EBSCOhost Web platform: MEDLINE with Full Text, CINAHL PLUS with Full Text, Academic Search Complete and Psychology and Behavioral Sciences Collection. Peer-reviewed articles published in English or Portuguese languages from 2018 to September 2023 were retrieved. Methodological quality was established using the Quality Assessment Tool for Observational, Cohort and Cross-Sectional Studies - NHLBI, NIH. Results: Ten studies met the eligibility criteria and were synthetized. The results revealed nine components, reflecting the way FCC was developed: shared decision-making; family education; respect for culture; family engagement; recognition of the family's needs, characteristics and interests; specialized care support; social and emotional support; family functionality; and family seen as a unit. The health outcomes demonstrate effective gains in improving children's health through family satisfaction with health services. Also achieved psychological and social benefits, with improved family well-being and quality of life, favoring family empowerment. Conclusions: The evidence suggests that FCC components involves an effective partnership between the family and health professionals as the main key in developing care plans, as well as the experience that the family unit brings to the delivery of care. FCC approach include all family members as decision-makers, providing emotional, physical and instrumental levels of support. Health outcomes emerged in three strands; for children with ID, families and health services.

Thermoregulatory response of black or red lactating Holstein cows in the hot and cold season in southern Brazil.

Dairy cows in pasture-based systems are more susceptible to heat stress. Holstein cows have the black or red phenotypes, the latter having lower absorbance of solar radiation. Therefore, the study's objective was to evaluate whether cows with red (R) coats are more resistant than black (B) cows to hot weather in a subtropical climate. R and B lactating Holstein cows were evaluated during the cold and hot seasons for internal and surface temperature and sweating rate. In the cold season, body temperature (n = 9/group) did not differ between groups, but the average superficial temperature (n = 13/group) was lower in R cows (B: 30.9 ± 0.3 °C; RW: 29.6 ± 0.3 °C; p = 0.02). In the hot season, under mild to moderate heat stress, mean body temperature (n = 9/group) of R cows was lower (B: 38.75 ± 0.01 °C; R: 38.62 ± 0.1 °C; p=<0.0001), whereas no difference was observed in superficial temperature (n = 17/group). The maximum internal temperature and sweating rate (n = 11/group), measured in the hot season, and the number of evaluations in hyperthermia in both seasons did not differ. Therefore, there were differences in thermoregulation between phenotypes under mild to moderate heat stress conditions. However, considering that only discrete differences were observed, the red and white coat is unlikely to benefit the Holstein cow's welfare under mild to moderate thermal stress.

Does GnRH treatment at TAI regardless of estrus occurrence increase pregnancy rate in crossbred Bos taurus suckled cows?

The impact of GnRH treatment on the day of TAI in beef cows has received limited investigation, especially concerning its association with estrus expression. Consequently, two experiments were conducted to assess the potential of GnRH treatment on the day of TAI to enhance fertility according to the expression or not of estrus in beef cows. Experiment 1 aimed to determine ovulation rate and luteal function, while Experiment 2 aimed to determine the effect of the two GnRH treatment approaches on pregnancy rate. In Experiment 1, multiparous Brangus suckling cows (n = 17) were submitted to an 8-day TAI protocol. Estrus occurrence was evaluated based on chalk removal on D10 (TAI) and cows were assigned to receive GnRH (25µg lecirelin; im) according to the group: GnRH (n = 7), regardless of estrus expression; or selectGnRH (n = 10), only cows not detected in estrus. Ovulation rate occurring until 77h after IVD removal did not differ (p = 0.17) between GnRH (85.7%; 6/7) and selectGnRH (100%; 10/10). Also, corpus luteum size and serum progesterone concentration were not affected (p>0.05) by treatments. In Experiment 2, crossbred taurine suckled cows (n = 384) were submitted to the same protocol as described in Experiment 1 and were randomly allocated to GnRH or selectGnRH groups. There was no difference in P/AI between groups (selectGnRH = 55.6%; GnRH = 54.3%; p = 0.7) 30 days after TAI. As expected, there was a pronounced effect (p<0.0001) of estrus expression on P/AI (Estrus = 61.5%; No estrus = 33.0%), regardless of group. In summary, ovulation timing and rate and luteal function did not differ between groups. Also, GnRH administration only in cows that do not show estrus is recommended, considering hormone savings and similar conception rate.

GnRH analogs induce a LH peak and increase pregnancy per timed-AI in ewes.

To date, there have been no studies testing the capacity of GnRH analogs and respective doses to induce a LH peak in sheep. In this sense, the present study aimed to evaluate the capacity of different synthetic forms and doses of GnRH in inducing LH release in sheep, and the effect of GnRH administration at timed artificial insemination (TAI) on pregnancy per timed-AI. In experiment 1, ewes (n = 40) received an intravaginal device (IVD) of medroxyprogesterone acetate (MPA; 60 mg) for 7 d and prostaglandin F2α analog on Day 5. On Day 7, the ewes were allocated randomly into one of eight groups (n = 5/group), which received a GnRH analog at a specific dose, as follows: lecirelin (12.5 or 25 µg), gonadorelin (50 or 100 µg), buserelin acetate (4.2 or 8.4 µg), or deslorelin (375 or 750 µg). Blood samples for LH determination were obtained at 0, 2, 4, and 6 h after GnRH and the IVDs were removed after the last blood collection. The maximal LH concentration induced by gonadorelin at doses of 50 µg and 100 µg (12.0 ± 2.4 ng/mL and 28.6 ± 7.1 ng/mL, respectively) was lower (P < 0.05) than serum LH induced by 8.4 µg of buserelin (78.9 ± 12.9 ng/mL), 375 µg and 750 µg of deslorelin (75.6 ± 7.4 ng/mL and 72.1 ± 10.6 ng/mL, respectively) and 12.5 µg and 25 µg of lecirelin (73.3 ± 17.8 ng/mL and 61.6 ± 5.9 ng/mL, respectively). However, the maximal LH concentration induced by 4.2 µg of buserelin (49.4 ± 5.9 ng/mL) was similar (P > 0.05) to the 100 µg of gonadorelin. The total release of LH (area under the curve - AUC) after treatment with 50 µg of gonadorelin (31.7 ± 5.9 ng h/mL) was lower (P < 0.05) than after other agonists. In a second experiment, 330 ewes were treated with IVD containing MPA for 7 d. Simultaneously with IVD removal, 250 µg of cloprostenol and 200 IU of eCG were administered. Then, ewes were assigned randomly to either no further treatment (control); or to receive 4.2 µg of buserelin acetate (GnRH group) at cervical TAI, which was performed with fresh semen 54 h after IVD withdrawal in all the animals. Higher pregnancy per timed-AI was observed for GnRH (50.3 %) compared to control (40.7 %). We conclude that buserelin acetate (8.4 µg), lecirelin (12.5 and 25 µg) and deslorelin (375 and 750 µg) induced a greater stimulatory effect on LH secretion than gonadorelin treatment. Furthermore, buserelin acetate treatment at TAI increased pregnancy per timed-AI in ewes previously treated with MPA and eCG.

Motility, oxidative status and morphology of frozen-thawed bovine semen are not impacted by fatty acid exposure in vitro.

While sperm migrate within the reproductive tract of cows experiencing negative energy balance (NEB), they come into contact with elevated concentrations of non-esterified fatty acids (NEFA). For this reason, this study aimed to investigate the effects of three different NEFA - palmitic acid (PA), stearic acid (SA), and oleic acid (OA) - on bovine sperm motility, kinetic parameters, oxidative status, and morphology. Frozen thawed semen samples from Bos taurus bulls were incubated with varying concentrations of each fatty acid, and the sperm's characteristics were analysed at different time points. Computer-Assisted Sperm Analysis (CASA) was employed to assess sperm motility and kinetic parameters. Concurrently, the production of the reactive oxygen species (ROS) and total antioxidant capacity were measured to determine the oxidative status. Additionally, sperm morphology was evaluated. In Experiment 1, different concentrations of PA did not show significant effects on total motility, progressive motility, or any kinetic parameters analysed. Similarly, PA did not have a significant impact on the oxidative status or sperm morphology. In Experiment 2, SA at various concentrations did not lead to significant changes in total motility, progressive motility, or any kinetic parameters evaluated. Furthermore, SA did not affect oxidative status or sperm morphology. In Experiment 3, the concentrations of OA used did not result in significant changes in total motility, progressive motility, or any kinetic parameters studied. Likewise, OA did not induce any alterations in oxidative status or sperm morphology. Overall, the results from all three experiments indicate that PA, SA and OA, at the in vitro conditions and tested concentrations, do not exert detrimental effects on bovine sperm function and morphology. These results provide insights that contribute to our understanding of how fatty acids can impact the reduction of fertility rates in cows facing NEB. This, in turn, lays the foundation for additional critical investigations in this area. Further studies are necessary to validate these findings in vivo.

Opportunistic Use of Computed Tomography to Determine Muscle-Adipose Ratio Reliably Predicts Wound Complications After Kocher-Langenbeck Surgical Exposure of the Acetabulum.

OBJECTIVES: To determine whether muscle-to-adipose ratio (MAR) along the course of a Kocher-Langenbeck incision is more accurate at predicting postoperative wound complications after acetabular fixation than waist-to-hip ratio or body mass index (BMI). DESIGN: Retrospective case series. SETTING: Level 1 Trauma Center. PATIENT SELECTION CRITERIA: Patients who sustained an acetabular fracture and had fixation through a Kocher-Langenbeck approach from January 1 st , 2008 to December 31 st , 2018. For inclusion, patients had to have a pre-operative and a post-operative CT of the pelvis and a minimum follow up of 12 months. Patients were excluded if an antibiotic other than cefazolin was administered for prophylaxis, if they had a femur fracture treated with an antegrade intramedullary nail, if there was any associated pelvic ring injury requiring surgical treatment of any type, if there were any abdominal or pelvic procedures completed by another surgical service, if the patient underwent pelvic embolization of a vessel, if there was presence of a genitourinary injury or Morel-Lavallée lesion, or if there was a subsequent surgical procedure unrelated to the primary endpoint (e.g., revision fixation). OUTCOME MEASURES AND COMPARISONS: Presence of a surgical site infection or a wound healing complication. BMI, WHR and MAR were evaluated and compared for their ability to predict a surgical site infection or a wound healing complication. RESULTS: One-hundred ninety-three patients were included in this study, and the mean follow-up was 17.4 months. Thirty patients (15.5%) developed a wound complication. Seventeen patients (8.8%) developed a superficial infection and 13 (6.7%) developed a deep infection. The mean BMI for those who developed a wound complication was 35.9. The mean MAR was 0.67 for patients who developed a wound complication versus 0.75 for those who did not. Receiver operator characteristic analysis showed an area under curve for BMI to be 0.717 (95% confidence interval [CI] 0.577-0.857, P = 0.006) and for MAR to be 0.680 (inverted, 95% CI, 0.507-0.854, P = 0.022). The area under curve for waist-to-hip ratio was not statistically significant. CONCLUSIONS: MAR is a significant predictor of postoperative wound complication in patients undergoing treatment of posterior wall acetabular fractures. The higher rate of wound complications in patients with a low MAR should be considered in the treatment of these patients and may be used to guide discussion regarding the risks of surgery and the potential use of adjuncts to reduce wound healing complications. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Perspective of Rehabilitation Nurses on Physical Exercise in the Rehabilitation of Older People in the Community: A Qualitative Study.

In the face of an increasingly aging population, nurses have to design and implement programs aimed at the elderly in order to keep them healthy and maintain their quality of life. Structured physical exercise and overall physical activity play a major role in maintaining an active lifestyle, improving health, preventing disease, and helping to maintain older people's quality of life. To investigate the importance of implementing physical exercise programs for the older person in the community, taking into account the perspective of the rehabilitation nurse specialist, this is a qualitative, exploratory, and descriptive study with nine rehabilitation nurses from various regions of Portugal who have experience of implementing physical exercise programs with the elderly. This study used semi-structured interviews, one of the most common data collection procedures in social and health research. Content analysis was used to analyze the data. The study received a positive opinion from the Ethics Committee. The participants' perspectives focused on the following subjects: "Physical exercise program for the elderly in the community", "Importance of physical exercise in the rehabilitation of the elderly in the community", "People's adherence to the programs", "Gains in health resulting from the implementation of these strategies" and "Gains from group activities". A set of indicators emerged from the analysis. Nurses recognize the importance of using structured physical exercise programs adjusted to the rehabilitation of the older person, with gains in promoting active and healthy aging.

JARID1B represses the osteogenic potential of human periodontal ligament mesenchymal cells.

BACKGROUND: Here, we evaluated whether the histone lysine demethylase 5B (JARID1B), is involved in osteogenic phenotype commitment of periodontal ligament cells (PDLCs), by considering their heterogeneity for osteoblast differentiation. MATERIALS AND METHODS: Epigenetic, transcriptional, and protein levels of a gene set, involved in the osteogenesis, were investigated by performing genome-wide DNA (hydroxy)methylation, mRNA expression, and western blotting analysis at basal (without osteogenic induction), and at the 3rd and 10th days of osteogenic stimulus, in vitro, using PDLCs with low (l) and high (h) osteogenic potential as biological models. RESULTS: h-PDLCs showed reduced levels of JARID1B, compared to l-PDLCs, with significant inversely proportional correlations between RUNX2 and RUNX2/p57. Epigenetically, a significant reduction in the global H3K4me3 content was observed only in h-PDLCs. Immunoblotting data reveal a significant reduction in the global H3K4me3 content, at 3 days of induction only in h-PDLCs, while an increase in the global H3K4me3 content was observed at 10 days for both PDLCs. Additionally, positive correlations were found between global H3K4me3 levels and JARID1B gene expression. CONCLUSIONS: Altogether, our results show the crucial role of JARID1B in repressing PDLCs osteogenic phenotype and this claims to pre-clinical protocols proposing JARID1B as a potential therapeutic target.

Clinical-epidemiological profile of traumatic brain injury associated with traffic accidents in southeastern Pará, in the Brazilian Amazon / Perfil clínico-epidemiológico de traumatismos cranioencefálicos associados a acidentes de trânsito no Sudeste do Pará, na Amazônia brasileira

Introduction: In Brazil, traumatic brain injury (TBI) represents about two thirds of all causes of death and are often associated with traffic accidents, causing overload of medium and high complexity services. Objectives:To describe the occurrence and clinical-epidemiological profile of TBIs associated with traffic accidents in a regional hospital in the southeast of the state of Pará. Materials and Methods: This is a cross-sectional analytical study. It was based on data from the medical and statistical archives service of a regional hospital, through the analysis of electronic medical records of patients treated with TBI resulting from traffic accidents in the period from 2016 to 2020. Results: Of the 20,077 overall hospitalizations recorded, 4.0% were associated with the occurrence of TBI, of which, 75.3% were directly caused by traffic accidents involving motorcycles. The cases were concentrated in individuals of mixed race, male, aged between 18 and 29 years, with percentages of 92.5%, 86% and 39%, respectively. Conclusions: The occurrence of TBIs associated with automobile accidents is a problem that requires attention in the region. Moreover, there were several gaps in the completion of the medical records, which made it difficult to determine the association of the outcome, alcohol consumption and the use of PPE. However, considering all the information presented, assertive local public policies aimed at prevention can be implemented. And this can be the starting point for promoting changes aimed at mitigating traffic accidents and bed occupations due to preventable causes, impacting the quality of health care and economic factors (AU).

Introdução: No Brasil, os traumatismos cranioencefálicos (TCEs) representam cerca dois terços de todas as causas de óbitos e são frequentemente associados a acidentes de trânsito, causando sobrecarga dos serviços de média e alta complexidade. Objetivos: Descrever a ocorrência e o perfil clínico-epidemiológico de TCEs associados a acidentes de trânsito em um hospital regional no Sudeste do Estado do Pará. Materiais e Métodos: Trata-se de um estudo analítico de corte transversal. Baseou-se em dados provenientes do serviço de arquivos médicos e estatísticos de um hospital regional, através da análise de prontuários eletrônicos de pacientes diagnosticados com TCE decorrentes de acidentes de trânsito no período de 2016 a 2020. Resultados: Das 20.077 internações gerais re-gistradas, 4,0% foram associadas à ocorrência de TCE, das quais 75,3% foram diretamente causados por acidentes de trânsito envolvendo motocicletas. Os casos se concentraram em indivíduos pardos, do sexo masculino, com faixa etária entre 18 e 29 anos, com percentuais de 92,5%, 86% e 39%, respectivamente. Conclusões: A ocorrência de TCEs associados a acidentes automobilísticos é um problema que requer atenção na região. Além disso, verificou-se várias lacunas no preenchimento dos prontuários, o que dificultou a determinação da associação do desfecho, o consumo de álcool e a utilização dos EPIs. No entanto, considerando todas as informações apresentadas, políticas públicas assertivas locais que visem a prevenção podem ser implementadas. E esse pode ser o ponto de partida para promover mudanças que visem mitigação dos acidentes de trânsito e ocupações de leitos por causas evitáveis, impactando na qualidade da assistência em saúde e fatores econômicos (AU).

Vitamin E reduces the reactive oxygen species production in dominant follicle during the negative energy balance in cattle.

In the postpartum period, there is an increase in non-esterified fatty acids (NEFA) in both serum and follicular fluid (FF) of cattle. The increase in fatty acid concentration results in increased production of reactive oxygen species (ROS) that can compromise bovine fertility. The objectives of this study were to characterize the lipid profile found in the FF of cows experiencing induced negative energy balance (NEB) and to evaluate the effect of α-tocopherol in the prevention of oxidative stress in the serum and FF of cows. Twenty-nine beef cows were divided into groups: (1) control; (2) Fasting for 24 days; and (3) Fasting + VitE. Between D0 and D4 blood samples were taken to assess concentrations of NEFA, ROS production, total antioxidant capacity (FRAP), lipid peroxidation, and α-tocopherol (vitamin E). On D4, follicular aspiration was performed for analysis of FF from the dominant follicle. Our results demonstrate that fasting was effective in causing increased fat mobilization in animals. The increase in serum concentration of C18:1c9 was reflected in the FF of fasting cows. Serum α-tocopherol concentration was higher in the control and Fasting + VitE groups compared to the Fasting group. In FF, there was an increase of α-tocopherol in the Fasting + VitE group in comparison to Fasting cows. There was an increase in ROS production in the serum of fasting cows. ROS production in FF was higher in the Fasting compared to the Fasting + VitE group. Vitamin E has beneficial effects in reducing ROS production in the dominant follicle of cows in NEB.

Analyzes In Silico Indicate the lncRNAs MIR31HG and LINC00939 as Possible Epigenetic Inhibitors of the Osteogenic Differentiation in PDLCs.

Chromatin conformation, DNA methylation pattern, transcriptional profile, and non-coding RNAs (ncRNAs) interactions constitute an epigenetic pattern that influences the cellular phenotypic commitment and impacts the clinical outcomes in regenerative therapies. Here, we investigated the epigenetic landscape of the SP7 transcriptor factor (SP7) and Distal-Less Homeobox 4 (DLX4) osteoblastic transcription factors (TFs), in human periodontal ligament mesenchymal cells (PDLCs) with low (l-PDLCs) and high (h-PDLCs) osteogenic potential. Chromatin accessibility (ATAC-seq), genome DNA methylation (Methylome), and RNA sequencing (RNA-seq) assays were performed in l- and h-PDLCs, cultured at 10 days in non-induced (DMEM) and osteogenic (OM) medium in vitro. Data were processed in HOMER, Genome Studio, and edgeR programs, and metadata was analyzed by online bioinformatics tools and in R and Python environments. ATAC-seq analyses showed the TFs genomic regions are more accessible in l-PDLCs than in h-PDLCs. In Methylome analyses, the TFs presented similar average methylation intensities (AMIs), without differently methylated probes (DMPs) between l- and h-PDLCs; in addition, there were no differences in the expression profiles of TFs signaling pathways. Interestingly, we identified the long non-coding RNAs (lncRNAs), MIR31HG and LINC00939, as upregulated in l-PDLCs, in both DMEM and OM. In the following analysis, the web-based prediction tool LncRRIsearch predicted RNA:RNA base-pairing interactions between SP7, DLX4, MIR31HG, and LINC00939 transcripts. The machine learning program TriplexFPP predicted DNA:RNA triplex-forming potential for the SP7 DNA site and for one of the LINC00939 transcripts (ENST00000502479). PCR data confirmed the upregulation of MIR31HG and LINC00939 transcripts in l-PDLCs (× h-PDLCs) in both DMEM and OM (p < 0.05); conversely, SP7 and DLX4 were downregulated, confirming those results observed in the RNA-Seq analysis. Together, these results indicate the lncRNAs MIR31HG and LINC00939 as possible epigenetic inhibitors of the osteogenic differentiation in PDLCs by (post)transcriptional and translational repression of the SP7 and DLX4 TFs.

Primary Cardiac Tumor in the Left Atrium: A Diagnostic Challenge.

An elderly man presented to the emergency department with shortness of breath, peripheral edema, and significant weight loss. Blood tests revealed anemia and elevated inflammatory markers, and chest imaging showed a massive left pleural effusion. During hospitalization, he developed subacute cardiac tamponade, and pericardiocentesis was performed. Further imaging revealed a primary malignant cardiac tumor with extensive infiltration of the cardiac tissue, and biopsy was deemed impossible due to the tumor's location. The most likely diagnosis was angiosarcoma. The cardiac surgery team evaluated the case and considered it inoperable due to the tumor's extensive infiltration. The patient is currently under the regular care of a palliative care team. This case underscores the difficulties of diagnosing primary cardiac tumors, particularly in elderly patients with comorbidities. Despite advances in imaging and surgical techniques, the prognosis for malignant cardiac tumors remains poor.

Long range gene flow beyond predictions from oceanographic transport in a tropical marine foundation species.

The transport of passively dispersed organisms across tropical margins remains poorly understood. Hypotheses of oceanographic transportation potential lack testing with large scale empirical data. To address this gap, we used the seagrass species, Halodule wrightii, which is unique in spanning the entire tropical Atlantic. We tested the hypothesis that genetic differentiation estimated across its large-scale biogeographic range can be predicted by simulated oceanographic transport. The alternative hypothesis posits that dispersal is independent of ocean currents, such as transport by grazers. We compared empirical genetic estimates and modelled predictions of dispersal along the distribution of H. wrightii. We genotyped eight microsatellite loci on 19 populations distributed across Atlantic Africa, Gulf of Mexico, Caribbean, Brazil and developed a biophysical model with high-resolution ocean currents. Genetic data revealed low gene flow and highest differentiation between (1) the Gulf of Mexico and two other regions: (2) Caribbean-Brazil and (3) Atlantic Africa. These two were more genetically similar despite separation by an ocean. The biophysical model indicated low or no probability of passive dispersal among populations and did not match the empirical genetic data. The results support the alternative hypothesis of a role for active dispersal vectors like grazers.

Depression in older adults during the COVID-19 pandemic: A systematic review.

BACKGROUND: Depression affected 5.7% of people aged 60 years and over prior to the pandemic and has increased by approximately 28%. The aim of this study is to identify and describe factors associated with depressive symptoms, the diagnostic assessment instruments and interventions used to evaluate and treat depression in adults aged 60 years and older since the onset of the COVID-19 pandemic. METHODS: Four electronic databases were systematically searched to identify eligible studies published since the beginning of the COVID-19 pandemic. A total of 832 articles were screened, of which 53 met the inclusion criteria. RESULTS: Factors contributing to depressive symptoms in older adults prior to the pandemic were grouped into the following categories: sociodemographic characteristics (i.e., being female); loneliness and weak social support; limitations in daily functioning, physical activity and neurocognitive impairment; and clinical factors. The following groups of factors directly related to the pandemic were found: stress-related factors and feelings or worries related to the pandemic; information access (e.g., receiving news about COVID-19 through the media); factors directly related to COVID-19 (e.g., having infected acquaintances); and factors related to the measures that were taken to reduce the spread of COVID-19 (e.g., confinement measures). The most frequently used instrument to assess depressive symptoms was the Geriatric Depression Scale Short Form (GDS-SF). Four studies implemented interventions during the pandemic that led to significant reductions in depressive symptoms and feelings of loneliness. CONCLUSIONS: Improved understanding of pandemic-associated risk factors for depression can inform person-cantered care. It is important continued mental healthcare for depression for older adults throughout crises, such as the COVID-19 pandemic. Remote delivery of mental healthcare represents an important alternative during such times. It is crucial to address depression in older adults (which often causes disability), since the pandemic situation has increased depressive symptoms in this population.

Nurses' Motivations, Barriers, and Facilitators to Engage in a Peer Review Process: A Qualitative Study Protocol.

Peer review supports the integrity and quality of scientific publishing. However, although it is a fundamental part of the publishing process, peer review can also be challenging for reviewers, editors, and other stakeholders. The present study aims to explore the nurses' motivations, barriers, and facilitators in engaging in a peer review process. This qualitative, descriptive exploratory study will be developed in partnerships with three research centers. Researchers followed the consolidated criteria for reporting qualitative research (COREQ) checklist to ensure the quality of this study protocol. According to the selection criteria, the purposive sampling will be used to recruit nurse researchers that act as peer reviewers for several scientific journals in various fields of knowledge. Interviews will be conducted until data have been sufficiently consistent with meeting the initial objectives. Researchers will develop a guide comprising a set of open-ended questions to collect participants' characteristics, descriptive review behavior, and perceptions regarding their motivations, barriers, and facilitators. Researchers will analyze data using an inductive process of content analysis with the help of the QDA Miner Lite database. Findings from this study will generate knowledge that may help stakeholders identify facilitating factors and barriers and guide the development of strategies to remove or minimize these barriers.

"Pra nós que somos negras, tudo é mais difícil". Cartografia de uma mulher negra em sofrimento psíquico / "For us who are black, everything is more difficult". Cartography of a black woman in psychological distress

Resumo O estudo tem como objetivos: cartografar a trajetória de racismo estrutural e de sofrimento psíquico de uma mulher negra acompanhada por uma enfermaria psiquiátrica em um Hospital Geral; e refletir sobre a relação entre o racismo estrutural e sofrimento psíquico. O racismo é a operacionalização tecnológica, destinada ao exercício do biopoder, que coloca negros em posições inferiores, determinando desvantagens a partir da raça. A violência racista impõe o debate para o campo da saúde mental por sua influência no sofrimento psíquico. Pesquisa qualitativa, descritiva e exploratória, com abordagem cartográfica, por meio da trajetória de uma usuária-cidadã-guia, utilizando-se da entrevista semiestruturada e do diário de campo cartográfico. A analise fez emergir as cenas: ser negra e como a sociedade nos vê; auto ódio; solidão da mulher negra, que demonstram como o sofrimento psíquico é influenciado pelo racismo estrutural que condicionam a existência do negro ao menor valor, à estigmatização e à desumanização. A subjetividade produzida internaliza sentimentos de inferioridade, de solidão, de auto-ódio e de não lugar. Torna-se urgente a problematização da questão racial na produção do cuidado em saúde mental, bem como uma reforma societária que proporcione a existência plena de direitos e de dignidade das pessoas negras.

Abstract The study aims to map the trajectory of structural racism and psychic suffering of a black woman accompanied by a psychiatric nursery in a General Hospital; and to reflect on the relationship between structural racism and psychic suffering. Racism is the technological operationalization, destined to the exercise of biopower, which places black people in inferior positions, determining disadvantages based on race. Racist violence imposes the debate on the field of mental health due to its influence on psychic suffering. Qualitative, descriptive and exploratory research, with a cartographic approach, through the trajectory of a user-citizen-guide, using a semi-structured interview and a cartographic field diary. The analysis made the scenes emerge: being black and how society sees us; self-hate; and loneliness of black women that demonstrate how psychic suffering is influenced by structural racism that condition the existence of black people to the lowest value, stigmatization and dehumanization. The subjectivity produced internalizes feelings of inferiority, loneliness, self-hatred and non-placement. It is urgent to problematize the racial issue in the production of mental health care, as well as a societal reform that provides the full existence of rights and dignity of black people.