Characteristics associated with the intention to complete advance directives and end-of-life preferences in Brazilians with heart failure

OBJECTIVE: To identify characteristics associated with an intention to complete advance directives (ADs) and end-of-life treatment preferences for outpatients with heart failure (HF). METHODS: A cross-sectional, analytical study. Sociodemographic and clinical data were collected from 108 patients with HF in an outpatient clinic in São Paulo, SP, Brazil. Quality of life (QoL) was assessed using the Minnesota Living with Heart Failure Questionnaire; knowledge about HF and the intention to complete ADs were assessed using a script. The relationships among variables were assessed through the chi-square and Mann-Whitney tests, with p < 0.05 considered significant. RESULTS: The intention to complete ADs was significantly associated with reporting adherence to pharmacological recommendations (99% vs. 88.1%, p = 0.02), worse QoL (29.7 ± 18.2 vs. 20.9 ± 11.0; p = 0.0336), perceived knowledge about HF (89.7% vs. 63.6%, p = 0.0495), not wishing the healthcare providers would decide about treatment (27.3% vs. 2.15, p = 0.0026), and considering ADs useful (91.8% vs. 27.3%, p < 0.001). End-of-life treatment preferences included living as long as possible (50.5%), not being sedated (37.1%), and staying close to family and friends for as long as possible (32.0%). CONCLUSIONS: Characteristics associated with an intention to complete ADs and end-of-life treatment preferences were identified in patients with HF.

Clinical validity of the nursing diagnosis risk for unstable blood glucose level in persons with type 2 diabetes mellitus: A case-control study.

OBJECTIVE: To assess clinical-causal validity evidence of the nursing diagnosis, risk for unstable blood glucose level (00179), in individuals with type 2 diabetes mellitus. METHODS: A case-control study was conducted in 5 primary healthcare units, involving 107 subjects with type 2 diabetes mellitus, 60 in the case group and 47 in the control group. Causality was determined by the association between sociodemographic and clinical factors, risk factors related to the nursing diagnosis, and the occurrence of unstable blood glucose level. An association was considered when the risk factor had a p-value of <0.05 and odds ratio >1. RESULTS: Risk factors, such as stress, inadequate physical activity, and low adherence to therapeutic regimen, were prevalent in the sample. Time since diagnosis between 1-5 and 6-10 years, multiracial ethnicity, and the risk factor of low adherence to therapeutic regimen increased the likelihood of the outcome. Completion of high school education was identified as a protective factor. CONCLUSIONS: The clinical validation of the nursing diagnosis, risk for unstable blood glucose level, has been successfully established, revealing a clear association between sociodemographic and clinical factors and the risk factors inherent to the nursing diagnosis. IMPLICATIONS FOR NURSING PRACTICE: The results contribute to advancing scientific knowledge related to nursing education, research, and practice and provide support for the evolution of nursing care processes for individuals with type 2 diabetes mellitus.

OBJETIVO: Avaliar a evidência de validade clínico­causal do diagnóstico de enfermagem, risco para nível instável de glicose no sangue (00179), em indivíduos com diabetes mellitus tipo 2. MÉTODO: Foi realizado um estudo caso­controle em cinco unidades básicas de saúde, envolvendo 107 indivíduos com diabetes mellitus tipo 2, 60 no grupo caso e 47 no grupo controle. A causalidade foi determinada pela associação entre fatores sociodemográficos e clínicos, fatores de risco relacionados ao diagnóstico de enfermagem e a ocorrência de nível instável de glicose no sangue. Uma associação foi considerada quando o fator de risco tinha um valor de p < 0.05 e odds ratio > 1. RESULTADOS: Fatores de risco como estresse, atividade física inadequada e baixa adesão ao regime terapêutico foram predominantes na amostra. O tempo desde o diagnóstico entre 1 e 5 anos e 6 a 10 anos, a etnia parda e o fator de risco baixa adesão ao regime terapêutico aumentaram a probabilidade do resultado. A conclusão do ensino médio foi identificada como um fator de proteção. CONCLUSÕES: A validação clínica do diagnóstico de enfermagem, risco para nível instável de glicose no sangue, foi estabelecida com sucesso, revelando uma clara associação entre fatores sociodemográficos e clínicos e os fatores de risco inerentes ao diagnóstico de enfermagem. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Os resultados contribuem para o avanço do conhecimento científico relacionado à educação, à pesquisa e à prática de enfermagem e fornecem suporte para a evolução dos processos de cuidados de enfermagem para indivíduos com diabetes.

Characteristics associated with the intention to complete advance directives and end-of-life preferences in Brazilians with heart failure.

OBJECTIVE: To identify characteristics associated with an intention to complete advance directives (ADs) and end-of-life treatment preferences for outpatients with heart failure (HF). METHODS: A cross-sectional, analytical study. Sociodemographic and clinical data were collected from 108 patients with HF in an outpatient clinic in São Paulo, SP, Brazil. Quality of life (QoL) was assessed using the Minnesota Living with Heart Failure Questionnaire; knowledge about HF and the intention to complete ADs were assessed using a script. The relationships among variables were assessed through the chi-square and Mann-Whitney tests, with p < 0.05 considered significant. RESULTS: The intention to complete ADs was significantly associated with reporting adherence to pharmacological recommendations (99% vs. 88.1%, p = 0.02), worse QoL (29.7 ± 18.2 vs. 20.9 ± 11.0; p = 0.0336), perceived knowledge about HF (89.7% vs. 63.6%, p = 0.0495), not wishing the healthcare providers would decide about treatment (27.3% vs. 2.15, p = 0.0026), and considering ADs useful (91.8% vs. 27.3%, p < 0.001). End-of-life treatment preferences included living as long as possible (50.5%), not being sedated (37.1%), and staying close to family and friends for as long as possible (32.0%). CONCLUSIONS: Characteristics associated with an intention to complete ADs and end-of-life treatment preferences were identified in patients with HF. IMPLICATIONS FOR NURSING PRACTICE: These results can help facilitate patients' completion of their ADs or activate their intention to maximize opportunities to exercise autonomy.

OBJETIVO: Identificar características associadas à intenção de completar diretivas antecipadas de vontade (DAV) e preferências de tratamento no final da vida de pacientes ambulatoriais com insuficiência cardíaca (IC). MÉTODOS: Estudo analítico, transversal. Foram coletados dados sociodemográficos e clínicos de 108 pacientes com IC atendidos em um ambulatório de São Paulo­SP, Brasil. A qualidade de vida (QV) foi avaliada por meio do Minnesota Living with Heart Failure Questionnaire, o conhecimento sobre IC e a intenção de completar as DAV foram avaliados por meio de um roteiro. As relações entre as variáveis foram avaliadas por meio dos testes qui­quadrado e Mann­Whitney, sendo considerado significativo p < 0,05. RESULTADOS: A intenção de completar as DAV foi significativamente associada ao relato de adesão às recomendações farmacológicas (99% vs 88,1%, p = 0,02), pior QV (29,7 ± 18,2 vs 20,9 ± 11,0; p = 0,0336), conhecimento percebido sobre IC (89,7% vs 63,6%, p = 0,0495), não desejar que os profissionais de saúde decidissem sobre o tratamento (27,3% vs 2,15, p = 0,0026) e considerar as DAV úteis (91,8% vs 27,3%, p < 0,001). As preferências de tratamento no final da vida incluíam viver o maior tempo possível (50,5%), não ser sedado (37,1%) e permanecer perto da família e amigos o maior tempo possível (32,0%). CONCLUSÕES: Foram identificadas características associadas à intenção de completar DAV e preferências de tratamento no final da vida em pacientes com IC. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Estes resultados podem ajudar a facilitar a conclusão das suas DAV pelos pacientes ou ativar a sua intenção de maximizar as oportunidades de exercício da autonomia.

Concept analysis of "Insufficient health literacy" in older adults and refinement of a diagnosis proposal.

PURPOSE: This study aims to conduct a thorough analysis of the concept of insufficient health literacy (IHL) in older adults and to refine a nursing diagnosis proposal while considering the specific characteristics of this demographic. METHODS: A comprehensive concept analysis was undertaken using Walker & Avant's method as a framework. FINDINGS: A systematic search across seventeen databases yielded 29 relevant studies for inclusion. Through analysis, we identified 15 antecedents, 3 attributes, and 7 consequents associated with IHL in older adults. CONCLUSIONS: The concept analysis brought clarity to the understanding of IHL within older adults, facilitating the refinement of a diagnosis proposal. This process was instrumental in establishing a diagnostic structure that accounts for the unique needs and challenges faced by older adults. IMPLICATIONS FOR NURSING PRACTICE: The structured diagnosis derived from the concept analysis provides a solid theoretical foundation for nurses specializing in Gerontology. By tailoring care interventions to address the specific requirements of older adults, this framework enhances the quality of nursing practice and contributes to improved patient outcomes in geriatric care settings.

OBJETIVO: Este estudo tem como objetivo realizar uma análise detalhada do conceito de Letramento em saúde insuficiente na população idosa e refinar uma proposta de diagnóstico de enfermagem, levando em consideração as características específicas desse público. MÉTODOS: Foi realizada uma análise conceitual abrangente utilizando o método de Walker & Avant. RESULTADOS: Uma busca sistemática em dezessete bases de dados resultou em 29 estudos relevantes para inclusão. Através da análise, identificamos quinze antecedentes, três atributos e sete consequentes associados ao Letramento em saúde insuficiente na população idosa. CONCLUSÕES: A análise conceitual trouxe clareza à compreensão do Letramento em saúde insuficiente na população idosa, facilitando o refinamento de uma proposta de diagnóstico. Esse processo foi fundamental para estabelecer uma estrutura diagnóstica que considera as necessidades e desafios únicos enfrentados pelos idosos. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: O diagnóstico estruturado derivado da análise conceitual fornece uma base teórica sólida para enfermeiros especializados em Gerontologia. Ao adaptar intervenções de cuidados para atender aos requisitos específicos dos idosos, esse framework melhora a qualidade da prática de enfermagem e contribui para resultados de pacientes aprimorados em ambientes de cuidados geriátricos.

Enteropathogenic Escherichia coli modulates the virulence and pathogenicity of Entamoeba dispar.

Amoebiasis is a disease caused by Entamoeba histolytica, affecting the large intestine of humans and occasionally leading to extra-intestinal lesions. Entamoeba dispar is another amoeba species considered commensal, although it has been identified in patients presenting with dysenteric and nondysenteric colitis, as well as amoebic liver abscess. Amoebic virulence factors are essential for the invasion and development of lesions. There is evidence showing that the association of enterobacteria with trophozoites contributes to increased gene expression of amoebic virulence factors. Enteropathogenic Escherichia coli is an important bacterium causing diarrhea, with high incidence rates in the world population, allowing it to interact with Entamoeba sp. in the same host. In this context, this study aims to evaluate the influence of enteropathogenic Escherichia coli on ACFN and ADO Entamoeba dispar strains by quantifying the gene expression of virulence factors, including galactose/N-acetyl-D-galactosamine-binding lectin, cysteine proteinase 2, and amoebapores A and C. Additionally, the study assesses the progression and morphological aspect of amoebic liver abscess and the profile of inflammatory cells. Our results demonstrated that the interaction between EPEC and ACFN Entamoeba dispar strains was able to increase the gene expression of virulence factors, as well as the lesion area and the activity of the inflammatory infiltrate. However, the association with the ADO strain did not influence the gene expression of virulence factors. Together, our findings indicate that the interaction between EPEC, ACFN, and ADO Entamoeba dispar strains resulted in differences in vitro and in vivo gene expression of Gal/GalNAc-binding lectin and CP2, in enzymatic activities of MPO, NAG, and EPO, and consequently, in the ability to cause lesions.

Digital Health Literacy Instrument: Brazilian Version-Cross-Cultural Adaptation and Content Validity for Individuals With Heart Failure.

Background and purpose: Assessment of digital health literacy should be a major concern for healthcare providers. We aimed to translate and adapt the Digital Health Literacy (DHL) Instrument into Brazilian Portuguese and examine the content validity for individuals with heart failure (HF). Methods: The instrument was translated, back translated, and evaluated by a panel of six experts regarding linguistic equivalences. An agreement analysis was performed, with values ≥80% considered acceptable. The experts then evaluated clarity, theoretical relevance, and practical pertinence. The content validity index (CVI) was calculated for each item. A CVI ≥.83 was considered acceptable. The expert's opinions were also evaluated through the modified kappa coefficient for content validity studies. Values >.74 were considered excellent. The content validity ratio (CVR) was also calculated. A critical value of CVR of 1.00 was determined. Cognitive testing (understanding the meaning of each item and their respective answers) was performed with 33 individuals with HF. Results: The adapted version obtained an agreement of ≥83.3% for each item on linguistic equivalences. Total CVI was ≥0.83, kappa values for each item were >.74, and the CVR values were 1.00 for all items. After two rounds of evaluation, all patients were able to understand the items and response scale. Conclusions: The Brazilian version has satisfactory evidence of linguistic and content validity to measure DHL in patients with HF. Additional psychometric properties will be tested in the country.

Evaluation of reference genes for gene expression analysis by real-time quantitative PCR (qPCR) in different tissues from mice infected by Ascaris suum.

Human ascariasis is the most prevalent helminth infection, affecting 445 million people worldwide. To better understand the impact of the immune system on the pathophysiology of individuals infected with Ascaris suum, mice have been used as experimental models. The RT-qPCR technique is a critical auxiliary tool of investigation used to quantify mRNA levels. However, proper normalization using reference genes is essential to ensure reliable outcomes to avoid analytical errors and false results. Despite the importance of reference genes for experimental A. suum infection studies, no specific reference genes have been identified yet. Therefore, we conducted a study to assess five potential reference genes (GAPDH, 18s, ACTB, B2M, and HPRT1) in different tissues (liver, lungs, small and large intestines) affected by A. suum larval migration in C57BL/6j mice. Tissue collection was carried out to analyze parasite burden and confirm the presence of larvae during the peak of migration in each tissue. Upon confirmation, we analyzed different genes in the tissues and found no common gene with stable expression. Our results highlight the importance of analyzing different genes and using different software programs to ensure reliable relative expression results. Based on our findings, B2M was ranked as the ideal reference gene for the liver, while 18S was the most stable gene in the lung and small intestine. ACTB, or a combination of ACTB with GAPDH, was deemed suitable as reference genes for the large intestine due to their stable expression and less variation between the control and infected groups. To further demonstrate the impact of using different reference genes, we normalized the expression of a chemokine gene (CXCL9) in all tissues. Significant differences in CXCL9 expression levels were observed between different groups in all tissues except for the large intestine. This underscores the importance of selecting appropriate reference genes to avoid overestimating target gene expression levels and encountering normalization-related issues that can lead to false results. In conclusion, our study highlights the significance of using reliable reference genes for accurate RT-qPCR analysis, especially in the context of A. suum infection studies in different tissues. Proper normalization is crucial to ensure the validity of gene expression data and avoid potential pitfalls in interpreting results.

Evidence of content validity of the nursing diagnosis risk for unstable blood pressure.

PURPOSE: To analyze evidence of content validity of the nursing diagnosis (ND) Risk for Unstable Blood Pressure in incarcerated women.  METHOD: A methodological study assessing the content validity of an ND, was performed in Brazil, between June and September 2022, with 49 nurses as experts. The label, definition, and relevance of the 19 risk factors of the ND Risk for Unstable Blood Pressure were appraised. Based on the predictive diversity model, the content validity index (CVI) and respective 95% confidence intervals were calculated for each risk factor. A CVI ≥ 0.8 was considered adequate evidence of content validity. FINDINGS: The label and the definition of the diagnosis was reformulated. The relevance of 19 etiological factors showed a CVI ≥ 0.8. According to the recommendation of the panel of experts, one of the etiological factors was split in two and two label of etiological factors were changed. CONCLUSIONS: A new label (Risk for Imbalanced Blood Pressure), new definition, and 20 etiological factors (11 risk factors, five associated conditions, and four at-risk populations) of the ND Risk for Unstable Blood Pressure in incarcerated women were considered valid. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I accepted the proposal for this nursing diagnosis; hence this study contributed to updating the classification based on scientific evidence. This evidence will favor diagnostic reasoning and recognition of the diagnosis during clinical assessment, and support studies assessing the clinical validity of these elements in incarcerated women.

OBJETIVO: Analisar evidências de validade de conteúdo do diagnóstico de enfermagem (DE) Risco de Pressão Arterial Instável em mulheres encarceradas. MÉTODO: Estudo metodológico de validade de conteúdo de um DE, realizado no Brasil, entre junho e setembro de 2022, tendo 49 enfermeiros como experts. Foram avaliados o título, a definição e a relevância dos 19 fatores de risco do DE Risco de Pressão Arterial Instável. Com base no modelo de diversidade preditiva, foram calculados o Índice de Validade de Conteúdo (IVC) e respectivos intervalos de confiança de 95% para cada fator de risco. IVC ≥ 0,8 foi considerado evidência adequada de validade de conteúdo. RESULTADOS: A relevância de 19 fatores etiológicos mostrou IVC ≥ 0,8. De acordo com a recomendação do painel de experts, um dos fatores etiológicos foi dividido em dois e dois rótulos de fatores etiológicos foram alterados. O título e a definição do diagnóstico foram reformulados. CONCLUSÃO: Foram considerados válidos um novo título (Risco de pressão arterial desequilibrada), nova definição e 20 fatores etiológicos (11 fatores de risco, cinco condições associadas e quatro populações de risco) do DE Risco de Pressão Arterial Instável em mulheres encarceradas. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A NANDA-I aceitou a proposta deste diagnóstico de enfermagem; portanto, este estudo contribuiu para a atualização da classificação baseada em evidências científicas. Essas evidências favorecerão o raciocínio diagnóstico e o reconhecimento do diagnóstico durante a avaliação clínica, além de subsidiar estudos que avaliem a validade clínica desses elementos em mulheres encarceradas.

Bioactive potential of Bio-C Temp demonstrated by systemic mineralization markers and immunoexpression of bone proteins in the rat connective tissue.

Intracanal medications are used in endodontic treatment due to their antibacterial activity and ability to induce the periapical repair. Among the intracanal medications, the Calen (CAL; SS. White, Brazil) is a calcium hydroxide-based medication that provides an alkaline pH and releases calcium, exerting an antimicrobial activity. Bio-C Temp (BIO; Angelus, Brazil), a ready-to-use bioceramic intracanal medication, was designed to stimulate the mineralized tissues formation. Here, we investigated the bioactive potential of BIO in comparison to the CAL in the rat subcutaneous. Polyethylene tubes filled with medications, and empty tubes (control group, CG) were implanted in the subcutaneous tissue of rats. After 7, 15, 30 and 60 days, the blood was collected for calcium (Ca+2) and alkaline phosphatase (ALP) measurement, and the capsules around the implants were processed for morphological analyses. The data were submitted to two-way ANOVA and Tukey test (p < 0.05). At 7, 15 and 30 days, the ALP level was grater in BIO and CAL than in CG (p < 0.0001). At 7 and 15 days, greater Ca+2 level was seen in the serum of CAL samples. From 7 to 60 days, an increase in the number of fibroblasts, osteocalcin- and osteopontin-immunolabelled cells was observed in BIO and CAL groups (p < 0.0001). In all periods, BIO and CAL specimens showed von Kossa-positive structures. Moreover, ultrastructural analysis revealed globules of mineralization in the capsules around the BIO and CAL specimens. Thus Bio-C Temp caused an increase in the ALP, osteocalcin and osteopontin, which may have allowed the formation of calcite, suggesting bioactive potential.

Development and validation of a case study to aid in the diagnostic reasoning of nursing students and nurses.

PURPOSE: The aim of this study is to develop and validate a case study to aid in the diagnostic reasoning of nursing students and nurses. METHODS: It is a validation study using a case study based on Lunney's method including (1) content validation of the case study by nurse experts through the Delphi technique, (2) identification of nursing diagnoses (NDs) in the case, (3) evaluation of diagnostic accuracy, and (4) establishment of a priority diagnosis by nurse experts. FINDINGS: The case study was developed from the findings of a narrative literature review on the cues of the NDs with a prevalence > 50% in patients with peripheral arterial occlusive disease. Two rounds of expert evaluation were required to validate the case study. The experts identified 18 NDs with different degrees of accuracy. The highly accurate diagnoses most frequently identified by the experts were: Ineffective peripheral tissue perfusion (100%), impaired walking (83%), impaired comfort (50%), and chronic pain (50%). The diagnosis considered a priority by all experts was ineffective peripheral tissue perfusion. CONCLUSIONS: The case study was developed and had its content validated. High-accuracy diagnoses were identified, and a priority was determined. IMPLICATIONS FOR NURSING PRACTICE: The validated case study may be used by students and nurses to facilitate the development of diagnostic reasoning and critical thinking in practice, teaching or research.

Deficient knowledge in patients with heart failure: A study of diagnostic accuracy and etiological relationships.

PURPOSE: To evaluate the accuracy of defining characteristics and causal relationships of the etiological factors of the nursing diagnosis deficient knowledge in individuals with heart failure . DATA SOURCES: An analytical, cross-sectional study on the diagnostic accuracy of the defining characteristics and causal relationships of the etiological factors of the nursing diagnosis. The sample consisted of 140 patients with chronic HF and in outpatient follow-up. The latent class analysis method was used to test the accuracy of measurements and estimate the prevalence of the diagnosis. The calculation of subsequent probabilities and the odds ratio ( were also parameters employed. The study was approved by the Research Ethics Committee of the Federal University of Pernambuco. DATA SYNTHESIS: The diagnosis had an estimated prevalence of 38.57% in the sample. The inaccurate statements about the disease and/or therapy, self-care deficient performance, and inadequate behavior were the clinical indicators that best predicted the presence of the diagnosis and demonstrated the same sensitivity value (1.0000), specificity (1.0000), and 95% confidence interval (0.9999-1.0000) for all. The populations at risk was elderly (OR = 2.12, confidence interval 95% = 1.05-4.27), and illiterate individuals (OR = 2.07, confidence interval 95% = 1.03-4.16) had an approximately twofold great chance of developing havening deficient knowledge. CONCLUSION: The evaluation of the accuracy of clinical indicators, corresponding to the defining characteristics in the study, contributed to screening and diagnostic establishment capacity in clinical practice, and to the translation of theoretical and practical knowledge. IMPLICATIONS FOR NURSING PRACTICE: Accurate clinical indicators of the nursing diagnosis deficient knowledge facilitate the clinical reasoning of nurses and favor the professional's role in the development of health education strategies focused on the acquisition of knowledge about the disease by patients, family members, and caregivers.

OBJETIVO: Avaliar a acurácia das características definidoras e relações causais dos fatores etiológicos do diagnóstico de enfermagem Conhecimento deficiente em pacientes com insuficiência cardíaca. FONTE DE DADOS: Estudo analítico, transversal, sobre a acurácia diagnóstica das características definidoras e relações causais dos fatores etiológicos do diagnóstico de enfermagem. A amostra foi composta por 140 pacientes com insuficiência cardíaca crônica e em acompanhamento ambulatorial. O método de análise de classes latentes foi utilizado para testar as medidas de acurácia e estimar a prevalência do diagnóstico. O cálculo de probabilidades posteriores e a Odds Ratio também foram parâmetros empregados. O estudo teve aprovação do Comitê de Ética em Pesquisa da Universidade Federal de Pernambuco. SÍNTESE DE DADOS: O diagnóstico apresentou prevalência estimada de 38,57% na população. As Declarações imprecisas sobre a doença e/ou terapêutica, Déficit no desempenho do autocuidado e Comportamento inadequado foram os indicadores clínicos que melhor predisseram a presença do diagnóstico e demonstraram o mesmo valor de sensibilidade (1.0000), especificidade (1.0000) e intervalo de confiança 95% (0.9999­1.0000) para todos. As populações em risco Idoso (Odds Ratio = 2.12, intervalo de confiança 95% = 1.05­4.27) e Indivíduos analfabetos (Odds Ratio = 2.07, intervalo de confiança 95% = 1.03­4.16) apresentaram, aproximadamente, duas vezes a chance de desenvolver o conhecimento deficiente. CONCLUSÃO: A avaliação da acurácia dos indicadores clínicos, correspondentes as características definidoras no estudo, contribuiu para a capacidade de triagem e estabelecimento de diagnósticos na prática clínica e para a tradução de conhecimentos teóricos e práticos. IMPLICAÇÕES PARA PRÁTICA DE ENFERMAGEM: Indicadores clínicos acurados do diagnóstico de enfermagem Conhecimento deficiente facilitam o raciocínio clínico do enfermeiro e favorecem a atuação do profissional na elaboração de estratégias de educação em saúde focadas na aquisição do conhecimento sobre a doença por parte de pacientes, familiares e cuidadores.

The long-lasting Ascaris suum antigens in the lungs shapes the tissue adaptation modifying the pulmonary architecture and immune response after infection in mice.

Ascariasis is the most prevalent helminth affecting approximately 819 million people worldwide. The acute phase of Ascariasis is characterized by larval migration of Ascaris spp., through the intestinal wall, carried to the liver and lungs of the host by the circulatory system. Most of the larvae subsequently transverse the lung parenchyma leading to tissue injury, reaching the airways and pharynx, where they can be expectorated and swallowed back to the gastrointestinal tract, where they develop into adult worms. However, some larvae are trapped in the lung parenchyma inciting an inflammatory response that causes persistent pulmonary tissue damage long after the resolution of infection, which returns to tissue homeostasis. However, the mechanism by which chronic lung disease develops and resolves remains unknown. Here, using immunohistochemistry, we demonstrate that small fragments and larval antigens of Ascaris suum are deposited and retained chronically in the lung parenchyma of mice following a single Ascaris infection. Our results reveal that the prolonged presence of Ascaris larval antigens in the lung parenchyma contributes to the persistent immune stimulation inducing histopathological changes observed chronically following infection, and clearly demonstrate that larval antigens are related to all phases of tissue adaptation after infection: lung injury, chronic inflammation, resolution, and tissue remodeling, in parallel to increased specific humoral immunity and the recovery of lung function in mice. Additional insight is needed into the mechanisms of Ascaris antigen to induce chronic immune responses and resolution in the host lungs following larval migration.

Determining the affinities of high-affinity antibodies using KinExA and surface plasmon resonance.

Accurate and efficient affinity measurement techniques are essential for the biophysical characterization of therapeutic monoclonal antibodies, one of the fastest growing drug classes. Surface plasmon resonance (SPR) is widely used for determining antibody affinity, but does not perform well with extremely high affinity (low picomolar to femtomolar range) molecules. In this study, we compare the SPR-based Carterra LSA and the kinetic exclusion assay (KinExA) for measuring the affinities of 48 antibodies generated against the SARS-CoV-2 receptor-binding domain. These data reveal that high-affinity antibodies can be generated straight from selections using high-quality in vitro library platforms with 54% correspondence between affinities measured using LSA and KinExA. Generally, where there was a 2-fold or greater difference between LSA and KinExA, KinExA reported that affinities were tighter. We highlight the differences between LSA and KinExA, identifying the benefits and pitfalls of each in terms of dynamic range and throughput. Furthermore, we demonstrate for the first time that single-point screening with KinExA can significantly improve throughput while maintaining a strong correlation with full binding curve equilibrium measurements, enabling the accurate rank-ordering of clones with exceptionally tight binding properties.

Cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for use on Brazilian adolescents.

The present study aimed to perform the cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for native Brazilian Portuguese-speaking adolescents (DHLI-BrA). Cross-cultural adaptation consisted of the following steps: translation, assessment, and adjustments by the expert committee to ensure cultural equivalence; back-translation, and synthesis of back-translations. Cognitive testing was then performed in a pretest with adolescents using cognitive interviews with probing questions on the item's understanding interpretation and response options. Cronbach's alpha coefficient and McDonald's omega were used to estimate the instrument's reliability. Forty-two Brazilian adolescents participated in the study (mean age: 16.0 ± 2.0 years; range: 13 to 19 years). Items that were difficult to understand were adapted to the context of Brazilian adolescents. Cronbach's alpha coefficient and McDonald's omega for the 21 items of the DHLI-BrA were, respectively, 0.79 and 0.80. Cronbach's alpha coefficient for the subscales of the self-report instrument was 0.53-0.79 (range), demonstrating good reliability in the total instrument and moderate reliability in the subscales. This study provides the cross-cultural adapted version of the Digital Health Literacy Instrument (DHLI), which is an instrument for measuring digital Health literacy, for use in Brazilian adolescents (DHLI-BrA).

Predictors of self-care behaviors in individuals with heart failure in Brazil.

OBJECTIVE: To identify the predictors of self-care behaviors in individuals with heart failure. METHOD: A cross-sectional study including 405 patients with heart failure. Self-care behaviors were assessed by the Self-Care of Heart Failure Index. Sociodemographic and clinical characteristics were investigated as predictors of self-care maintenance, management and confidence through logistic regressions. RESULTS: The predictors of self-care maintenance were number of children (p<0.01), left ventricular ejection fraction (p<0.01), positive feeling about disease (p=0.03), obesity (p=0.02) and dialytic chronic kidney disease (p<0.01). The predictors of self-care management were having married children (p<0.01) and sleep apnea (p<0.01). The predictors of self-care confidence were family income (p<0.01), number of hospitalizations in the previous 12 months (p=0.01), number of daily medication doses (p<0.01) and sedentarism (p<0.01). CONCLUSION: Some predictors related to the self-care behaviors were found, so some intensified education and social aid should be aimed at patients with these specific characteristics.

Nursing diagnosis proposal "Impaired Peripheral Venous Return": concept formation.

OBJECTIVES: to develop a nursing diagnosis proposal focused on venous return. METHODS: this is a concept analysis according to the model proposed by Walker and Avant, which is operationalized through an integrative review. The study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol recommendations. RESULTS: the analysis of the 131 studies allowed identifying attributes, antecedents and consequences. The most common attribute was decreased venous flow. The antecedents most frequently found were structural and/or functional valve deficiency, advanced age and peripheral venous thrombosis. The most common consequences were peripheral edema, venous ulcer and pain in the extremity. CONCLUSIONS: the formulated nursing diagnosis was proposed as part of Domain 4, Activity/rest, in Class 4, Cardiovascular/pulmonary responses, with eight defining characteristics, five related factors, six at-risk populations and four associated conditions.

Insights into next generation sequencing guided antibody selection strategies.

Therapeutic antibody discovery often relies on in-vitro display methods to identify lead candidates. Assessing selected output diversity traditionally involves random colony picking and Sanger sequencing, which has limitations. Next-generation sequencing (NGS) offers a cost-effective solution with increased read depth, allowing a comprehensive understanding of diversity. Our study establishes NGS guidelines for antibody drug discovery, demonstrating its advantages in expanding the number of unique HCDR3 clusters, broadening the number of high affinity antibodies, expanding the total number of antibodies recognizing different epitopes, and improving lead prioritization. Surprisingly, our investigation into the correlation between NGS-derived frequencies of CDRs and affinity revealed a lack of association, although this limitation could be moderately mitigated by leveraging NGS clustering, enrichment and/or relative abundance across different regions to enhance lead prioritization. This study highlights NGS benefits, offering insights, recommendations, and the most effective approach to leverage NGS in therapeutic antibody discovery.

Cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for use on Brazilian adolescents

Abstract The present study aimed to perform the cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for native Brazilian Portuguese-speaking adolescents (DHLI-BrA). Cross-cultural adaptation consisted of the following steps: translation, assessment, and adjustments by the expert committee to ensure cultural equivalence; back-translation, and synthesis of back-translations. Cognitive testing was then performed in a pretest with adolescents using cognitive interviews with probing questions on the item's understanding interpretation and response options. Cronbach's alpha coefficient and McDonald's omega were used to estimate the instrument's reliability. Forty-two Brazilian adolescents participated in the study (mean age: 16.0 ± 2.0 years; range: 13 to 19 years). Items that were difficult to understand were adapted to the context of Brazilian adolescents. Cronbach's alpha coefficient and McDonald's omega for the 21 items of the DHLI-BrA were, respectively, 0.79 and 0.80. Cronbach's alpha coefficient for the subscales of the self-report instrument was 0.53-0.79 (range), demonstrating good reliability in the total instrument and moderate reliability in the subscales. This study provides the cross-cultural adapted version of the Digital Health Literacy Instrument (DHLI), which is an instrument for measuring digital Health literacy, for use in Brazilian adolescents (DHLI-BrA).

Resumo O estudo teve o objetivo de adaptar transculturalmente o Digital Health Literacy Instrument (DHLI) para adolescentes nativos do idioma português do Brasil (DHLI-BrA). O estudo de adaptação transcultural consistiu nas seguintes etapas: tradução, avaliação e adequação de equivalência cultural da tradução por comitê de especialistas; retrotradução e síntese das retrotraduções. Foi realizada a testagem cognitiva em pré-teste com adolescentes, utilizando-se entrevistas cognitivas com perguntas de sondagem sobre a compreensão e interpretação dos itens e opções de resposta. O alfa de Cronbach e ômega de McDonald's foram utilizados para estimar a confiabilidade do instrumento. Participaram do pré-teste 42 adolescentes brasileiros com média de idade de 16,0 ± 2,0 (variação de 13-19) anos. Os itens com dificuldade de compreensão foram adaptados ao contexto dos adolescentes brasileiros. O coeficiente alfa de Cronbach e o ômega de McDonald's, para os 21 itens do DHLI-BrA foi respectivamente, 0,79 e 0,80. O coeficiente alfa de Cronbach para as subescalas do instrumento de autorrelato foi de 0,53-0,79 (variação), demonstrando boa confiabilidade no instrumento total e confiabilidade moderada nas subescalas. Este estudo fornece a versão adaptada transculturalmente do Digital Health Literacy Instrument (DHLI), um instrumento de mensuração do letramento digital em saúde, para utilização em adolescentes brasileiros (DHLI-BrA).