Antibacterial Prodrugs to Overcome Bacterial Antimicrobial Resistance.

Antimicrobial resistance (AMR) is an increasingly concerning phenomenon that requires urgent attention because it poses a threat to human and animal health. Bacteria undergo continuous evolution, acquiring novel resistance mechanisms in addition to their intrinsic ones. Multidrug-resistant and extensively drug-resistant bacterial strains are rapidly emerging, and it is expected that bacterial AMR will claim the lives of 10 million people annually by 2050. Consequently, the urgent need for the development of new therapeutic agents with new modes of action is evident. The antibacterial prodrug approach, a strategy that includes drug repurposing and derivatization, integration of nanotechnology, and exploration of natural products, is highlighted in this review. Thus, this publication aims at compiling the most pertinent research in the field, spanning from 2021 to 2023, offering the reader a comprehensive insight into the AMR phenomenon and new strategies to overcome it.

Unveiling the data: An analysis of plastic waste with emphasis on the countries of the E³UDRES2 alliance.

This paper offers an examination of the current plastic waste landscape, with emphasis on the nine countries of the European University Alliance E³UDRES2, based on both the literature and official numbers, to verify the alignment of practical waste management practices with scientific tendencies and advancements. The paper includes a bibliometric analysis focusing on the overall plastic waste literature and the plastic waste literature of the E³UDRES2 countries. Additionally, a mass balance was calculated regarding the domestic waste management of each of the alliance countries in 2021. The main goal is to assess how scientific research in the field of plastic waste management is being implemented in practice, particularly in the context of the E³UDRES2 countries. Bibliometric results reveal significant growth in publications since 2006, with China, the USA, and India leading. Key themes reveal evident clusters around behavior and technology, encompassing both the properties of plastics and societal attitudes toward waste management policy measures. Mass balance results reveal that, in the nine countries of the alliance, Latvia and Finland exhibited high plastic recycling rates (85% and 49%, respectively), and Germany, despite its high population, generated less waste per capita and incinerated 64% of its plastic waste. Despite progress, the results highlight ongoing challenges in implementing comprehensive circular economy-focused policies for waste management in Europe yet reveal a growing commitment to improving waste treatment systems, leading to lower environmental impacts of plastic waste.

Amphichorda monjolensis sp. nov., a new fungal species isolated from a Brazilian limestone cave, with an update on acremonium-like species in Bionectriaceae.

Caves are unique environments characterized by spatial limitations, partial or total absence of direct light, and scarcity of organic carbon and nutrients. Caves are shelters for a variety of adapted animals and microorganisms such as fungi, many of which are still unknown. Amphichorda is a fungal genus belonging to the family Bionectriaceae, which includes cave-dwelling and entomopathogenic species with biotechnological applications. In this study, a new fungal species was identified using morphological and multi-locus phylogenetic analyses of the ITS, LSU, and TEF loci, in the Gruta Velha Nova limestone cave located in the Southern Espinhaço Range, Monjolos, Minas Gerais, Brazil. During the exposure of potato dextrose agar plates to the cave environment, an insect from the family Rhaphidophoridae passed by and fed on the culture medium, resulting in three fungal isolates. Phylogenetic analyses showed that these isolates formed a clade distinct from all known species, leading us to introduce a new species, Amphichorda monjolensis, which may be associated with this insect. Here, we also proposed two new combinations for species of acremonium-like fungi in the Bionectriaceae: Bulbithecium globosisporum (synonym: Acremonium globosisporum) and Hapsidospora curva (synonym: Acremonium curvum). The discovery of A. monjolensis highlights the potential of caves as shelters for new species with significant biotechnological importance.

Intestinal microbial diversity of swines fed with different sources of lithium.

A drug that is widely used in the treatment of psychiatric disorder is lithium (Li) salts. The people who make therapeutic use of this drug develop a series of side effects. Through metataxonomic data, this study assessed the impacts of lithium, as Li carbonate or Li-enriched mushrooms, on the microbial composition of the ileum, colon, and feces of piglets. Employing Bray-Curtis metric, no differences were observed among the treatments evaluated. Nevertheless, the alpha diversity indices showed differences in the Simpson, Shannon, and Chao-1 indices in the colon and Chao-1 in the feces in the diets with Li compared with the diets without Li. The taxa with the highest relative abundance varied among the ileum, colon, and feces, with a predominance of the phyla Firmicutes, Bacteroidota, and Proteobacteria in diets with Li. Many groups of microorganisms that are important for the health of the host (e.g., Lactobacillus, Ruminococcaceae, Enterorhabdus, Muribaculaceae, and Coprococcus) had their relative abundance increased in animals that received diets with the recommended dose of lithium. Furthermore, there was an increase in the abundance of Prevotellaceae and Bacteroidales (in the diet with Li-enriched mushroom) and Clostridia, Ruminococcus, Burkholderia, and Bacteroidales (diets with Li carbonate) at the recommended dosages. This is the first study to show the effects of Li carbonate and Li-enriched mushrooms on the intestinal microbiota of piglets. Thus, the effects of lithium on the body may be related to its ability to change the composition of the intestinal microbiota. Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-024-03938-3.

Machine learning-based soil quality assessment for enhancing environmental monitoring in iron ore mining-impacted ecosystems.

In November 2015, a catastrophic rupture of the Fundão dam in Mariana (Brazil), resulted in extensive socio-economic and environmental repercussions that persist to this day. In response, several reforestation programs were initiated to remediate the impacted regions. However, accurately assessing soil health in these areas is a complex endeavor. This study employs machine learning techniques to predict soil quality indicators that effectively differentiate between the stages of recovery in these areas. For this, a comprehensive set of soil parameters, encompassing 3 biological, 16 chemical, and 3 physical parameters, were evaluated for samples exposed to mining tailings and those unaffected, totaling 81 and 6 samples, respectively, which were evaluated over 2 years. The most robust model was the decision tree with a restriction of fewer levels to simplify the tree structure. In this model, Cation Exchange Capacity (CEC), Microbial Biomass Carbon (MBC), Base Saturation (BS), and Effective Cation Exchange Capacity (eCEC) emerged as the most pivotal factors influencing model fitting. This model achieved an accuracy score of 92% during training and 93% during testing for determining stages of recovery. The model developed in this study has the potential to revolutionize the monitoring efforts conducted by regulatory agencies in these regions. By reducing the number of parameters that necessitate evaluation, this enhanced efficiency promises to expedite recovery monitoring, simultaneously enhancing cost-effectiveness while upholding the analytical rigor of assessments.

Recent antibacterial carbohydrate-based prodrugs, drugs and delivery systems to overcome antimicrobial resistance.

Antimicrobial resistance is an increasing phenomenon that is threatening global health. Tuberculosis causative bacteria and several resistant and multidrug-resistant bacteria are widely spread and listed by the World Health Organization as global priorities for research and development. Hence, new antibacterial agents with new modes of action are urgently required. In this context, carbohydrate-based drugs have been extensively studied and used, presenting several benefits for therapeutical purposes. In this review, the latest efforts done in the carbohydrate-based antibacterial agents research field, reported from 2021 to 2023, are summarized. Carbohydrate-based prodrugs, drugs, and delivery systems are covered, highlighting derivatization of existing antibiotics, use of nanotechnology, and repurposing of available therapeutical agents as the most popular strategies used in antibacterial agents' development.

Recurrent multi-stressor floc treatments with sulphide and free ammonia enabled mainstream partial nitritation/anammox.

Selective suppression of nitrite-oxidising bacteria (NOB) over aerobic and anoxic ammonium-oxidising bacteria (AerAOB and AnAOB) remains a major challenge for mainstream partial nitritation/anammox implementation, a resource-efficient nitrogen removal pathway. A unique multi-stressor floc treatment was therefore designed and validated for the first time under lab-scale conditions while staying true to full-scale design principles. Two hybrid (suspended + biofilm growth) reactors were operated continuously at 20.2 ± 0.6 °C. Recurrent multi-stressor floc treatments were applied, consisting of a sulphide-spiked deoxygenated starvation followed by a free ammonia shock. A good microbial activity balance with high AnAOB (71 ± 21 mg N L-1 d-1) and low NOB (4 ± 17 % of AerAOB) activity was achieved by combining multiple operational strategies: recurrent multi-stressor floc treatments, hybrid sludge (flocs & biofilm), short floc age control, intermittent aeration, and residual ammonium control. The multi-stressor treatment was shown to be the most important control tool and should be continuously applied to maintain this balance. Excessive NOB growth on the biofilm was avoided despite only treating the flocs to safeguard the AnAOB activity on the biofilm. Additionally, no signs of NOB adaptation were observed over 142 days. Elevated effluent ammonium concentrations (25 ± 6 mg N L-1) limited the TN removal efficiency to 39 ± 9 %, complicating a future full-scale implementation. Operating at higher sludge concentrations or reducing the volumetric loading rate could overcome this issue. The obtained results ease the implementation of mainstream PN/A by providing and additional control tool to steer the microbial activity with the multi-stressor treatment, thus advancing the concept of energy neutrality in sewage treatment plants.

Lentinula edodes lignocellulolases and lipases produced in Macaúba residue and use of the enzymatic extract in the degradation of textile dyes.

Agro-industrial residue and textile effluents have caused environmental damage to soil and water bodies. The production of fungal enzymes using agro-industrial residues and the use of these enzymes in the degradation of textile dyes can be a viable alternative to reduce these environmental damages. Lentinula edodes is a white rot fungus with high nutritional value that produces edible mushrooms and enzymes of commercial interest. Thus, the objectives of this study were to produce, purify, and biochemically characterize the lignocellulolytic enzymes and lipases produced for L. edodes in Macaúba coconut and to evaluate their potential for the degradation of textile dyes. The L. edodes UFV 73 had maximum enzymatic activity at 37 days of incubation. After the purification steps, the laccase, manganese peroxidase (MnP), cellulase, and, xylanase yields were 489.01, 264.2, 105.02, and 9.5%. The optimum temperature of cellulase activity did not change from 4 to 60 °C. The MnP, laccase, and lipase had activity directly proportional to the increase in temperature, while the cellulase and xylanase activity did not change. The optimum pH varied among analyzed enzymes. All the enzymes analyzed are according to Michaelis-Menten kinetics. The lignocellulolytic enzymes were stable up to 8 h of incubation and lipase had a reduction of activity after one hour. The discoloration rate of indigo dye by partially purified enzymatic extract (PPPE) was 40%, which shows its potential for degradation of dyes from textile industries.

Two new Cladosporium species from a quartzite cave in Brazil.

Caves are underground and natural environments mainly found in rocky terrain. Caves have a very specific microclimate, which benefits the occurrence of specific fungi. In recent studies, researchers have observed that caves harbour a great diversity of fungi. However, studies on fungal diversity in Brazilian caves are still incipient. In September 2019, airborne spore and soil samples were collected from the Monte Cristo cave, in the Southern Espinhaço Range, Diamantina, Minas Gerais state, Brazil. Two Cladosporium single-spore isolates, among other genera, were obtained from these samples. This study aimed to characterise these two fungal isolates based on their DNA sequence data and morphology. Phylogenetic analyses of the rDNA-ITS, ACT and TEF1-α loci revealed that the isolates belonged to the Cladosporium cladosporioides species complex. Both isolates did not cluster with any known species and were formally described and named herein as C. diamantinense and C. speluncae. This study presents taxonomic novelties and contributes to the knowledge about the fungal diversity in Brazilian caves.

Microbiomes associated with Coffea arabica and Coffea canephora in four different floristic domains of Brazil.

Brazilian coffee production relies on the cultivation of Coffea arabica and Coffea canephora. Climate change has been responsible for the decreasing yield of the crops in the country yet the associated microbial community can mitigate these effects by improving plant growth and defense. Although some studies have tried to describe the microorganisms associated with these Coffea species, a study that compares the microbiome on a wider spatial scale is needed for a better understanding of the terroir of each coffee planting region. Therefore, our aim was to evaluate the microbial communities harbored in soils and fruits of these Coffea species in four Brazilian floristic domains (Amazon, Atlantic Forest Caatinga, and Cerrado). One hundred and eight samples (90 of soil and 90 of fruits) were used in the extraction and sequencing of the fungal and bacterial DNA. We detected more than 1000 and 500 bacterial and fungal genera, respectively. Some soil microbial taxa were more closely related to one coffee species than the other species. Bacillus bataviensis tends to occur more in arid soils from the Caatinga, while the fungus Saitozyma sp. was more related to soils cultivated with C. arabica. Thus, the species and the planting region (floristic domain) of coffee affect the microbial composition associated with this crop. This study is the first to report microbial communities associated with coffee produced in four floristic domains that include sites in eight Brazilian states. Data generated by DNA sequencing provides new insights into microbial roles and their potential for the developing more sustainable coffee management, such as the production of biofertilizers and starter culture for fermentation of coffee cherries.

Which irrigating provides a better bond strength in glass fiber posts: Chlorhexidine or Sodium Hypochlorite? A systematic review with meta-analysis.

Background: The aim of this systematic review and meta-analysis was to evaluate the influence of the use of chlorhexidine on endodontic instrumentation on the bond strength of glass fiber posts with resin cements. The guiding question of the study was: "Is the bond strength of glass fiber posts greater when using chlorhexidine as an irrigator in endodontic treatment instead of sodium hypochlorite?". Material and Methods: This study was conducted according to Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). In vitro studies were included that have compared chlorhexidine and sodium hypochlorite as an endodontic irrigator in the chemical-mechanical preparation. Results: Eight studies were included in the qualitative analysis and seven in the meta-analysis. Both the analysis by subgroups and the total analysis, using a random effect model, showed no statistically significant differences between the groups (p> 0.05), either in the specific analysis for cervical root third (p = 0.30; 95% CI = -2.11, 6.91) or medium (p = 0.05; 95% CI = -0.03, 4.56), or nonspecific regarding the third to the root third (p = 0.48; 95% CI = -4.00, 1.86). Conclusions: There are no statistically significant differences in the bond strength of glass fiber posts and resin cements in teeth endodontically treated under irrigation by both chlorhexidine and sodium hypochlorite. Key words:Chlorhexidine, sodium hypochlorite, bond strength, glass fiber post.

Bioavailability of Li-enriched mushrooms and protection against oxidative stress in pigs: First study in vivo.

Mycelia and mushrooms are able to bioaccumulate minerals. Lithium is the active principle of drugs used in the treatment of psychiatric diseases. However, a dietary source of Li can reduce the side effects of these drugs. Thus, the objective of this study was to evaluate the bioavailability of Li-enriched mushroom of Pleurotus djamor in pigs and the effects of this element on oxidative stress in the animal tissues. Pigs 28-30 days-old were fed with diets containing or not Li for five days. Levels of serum cortisol were related to the Li dosage from diet. Li-enriched mushrooms were more bioavailable source of Li to the body than Li2CO3. These mushrooms also improved the effects of oxidative enzymes and showed less oxidative damage than Li2CO3. These results demonstrate the potential to use Li-enriched P. djamor as a source of Li that is more bioavailable and present protective effects against oxidative stress.

Nucleoside analogues: N-glycosylation methodologies, synthesis of antiviral and antitumor drugs and potential against drug-resistant bacteria and Alzheimer's disease.

Nucleosides have gained significant attention since the discovery of the structure of DNA. Nucleoside analogues may be synthesized through multiple synthetic pathways, however the N-glycosylation of a nucleobase is the most common method. Amongst the different classical N-glycosylation methodologies, the Vorbrüggen glycosylation is the most popular method. This review focuses on the synthesis and therapeutic applications of several FDA approved nucleoside analogues as antiviral and anticancer agents. Moreover, this review also focuses on the potential of these compounds as new antibacterial and anti-Alzheimer's disease agents, offering an overview of the most recent research in these fields.

Spiritual Experiences of Portuguese Women Who had a Water Birth.

This study aimed to understand the significance of spirituality to Portuguese women who had a water birth. In-depth interviews, using a semi-structured questionnaire, were conducted with 24 women who experienced water birth at the hospital or home. Results were analyzed from a narrative interpretation perspective. Three spirituality-related categories emerged: (1) Beliefs and connections with the body; (2) Spirituality: integration of being a woman and transformation during birth; and (3) Spirituality as wisdom, intuition, or the sixth sense. Spirituality was perceived in women's faith and beliefs in a superior being that helped them manage the unpredictability and uncontrollability of giving birth.

Possible strategies to reduce altitude-related excessive polycythemia.

We sought to determine the effects of three treatments on hemoglobin (Hb) levels in patients with chronic mountain sickness (CMS): 1) descent to lower altitude, 2) nocturnal O2 supply, 3) administration of acetazolamide. Nineteen patients with CMS living at an altitude of 3,940 ± 130 m participated in the study, which consisted of a 3-wk intervention phase and a 4-wk postintervention phase. Six patients spent 3 wk at an altitude of 1,050 m (low altitude group, LAG), six received supplemental oxygen for 12 h overnight (oxygen group, OXG), and seven received 250 mg of acetazolamide daily (acetazolamide group, ACZG). Hemoglobin mass (Hbmass) was determined using an adapted carbon monoxide (CO) rebreathing method before, weekly during, and 4 wk postintervention. Hbmass decreased by 245 ± 116 g (P < 0.01) in the LAG and by 100 ± 38 g in OXG, and 99 ± 64 g in ACZG (P < 0.05, each), respectively. In LAG, hemoglobin concentration ([Hb]) decreased by 2.1 ± 0.8 g/dL and hematocrit by 7.4 ± 2.9% (both P < 0.01), whereas OXG and ACZG only trended toward lower values. Erythropoietin concentration ([EPO]) decreased between 81 ± 12% and 73 ± 21% in LAG at low altitude (P < 0.01) and increased by 161 ± 118% 5 days after return (P < 0.01). In OXG and ACZG, the [EPO] decrease was ∼75% and ∼50%, respectively, during the intervention (P < 0.01). Descent to low altitude (from 3,940 m to 1,050 m) is a fast-acting measure for the treatment of excessive erythrocytosis in patients with CMS, reducing Hbmass by 16% within 3 wk. Nighttime oxygen supplementation and daily acetazolamide administration are also effective, but reduce Hbmass by only 6%.NEW & NOTEWORTHY To our knowledge, this is the first study examining the effect of three different treatments [descending to lower altitude (from 3,900 m to 1,050 m), nocturnal oxygen supply, and administration of acetazolamide] on changes in hemoglobin mass in patients experiencing chronic mountain sickness (CMS). We report that descent to low altitude is a fast-acting measure for the treatment of excessive erythrocytosis in patients with CMS, reducing Hbmass by 16% within 3 wk. Nighttime oxygen supplementation and daily acetazolamide administration are also effective, but reduce Hbmass by only 6%. In all three treatments, the underlying mechanism is a reduction in plasma erythropoietin concentration due to higher oxygen availability.

Effect of Selenium-Enriched Substrate on the Chemical Composition, Mineral Bioavailability, and Yield of Edible Mushrooms.

Mushrooms absorb minerals from substrates in which they are cultivated, so they could be used as vehicles of minerals that are deficient in human or animal diets, such as selenium. Selenium deficiency aggravates cardiovascular diseases, diabetes mellitus, and intestinal cancer. This work presents the latest discoveries related to the production of edible mushrooms in selenium-enriched substrates and discusses their use as an alternative to supply the deficiency of this mineral in human and animal diets. Selenized mushrooms and their derived extracts present bioaccessible and bioavailable forms of selenium, as antioxidant and antitumor activity, as demonstrated in various in vitro and in vivo experiments. Consequently, the consumption of these mushrooms reduces the levels of blood cholesterol and glucose. On the other hand, growing mushrooms in selenium-enriched substrates may alter the yield and their chemical composition, and this lack of standardization is still an obstacle to the scale up of the production process. On the other hand, the use of agro-industrial by-products as substrates can enable the cultivation of enriched edible mushrooms and their commercialization.

Demandas de autocuidado no parto na água: estudo qualitativo / Demandas de autocuidado en el parto en el agua: estudio cualitativo / Self-care demands in water birth: a qualitative study

Resumo Objetivo Analisar a compreensão de puérperas sobre a participação da enfermeira obstetra/obstetriz no parto na água, sob a luz da teoria do autocuidado. Métodos Estudo qualitativo por meio da técnica de análise de conteúdo com a participação de 21 mulheres portuguesas que tiveram o seu parto na água, em ambiente hospitalar. Foi utilizado, como referencial teórico o conceito de autocuidado, proposto por Dorothea Orem. Resultados Aflorou uma grande categoria "Necessidade de Autocuidado no Contexto do Parto na Água", cujas unidades de significados foram: Medo de não conseguir vivenciar o parto na água, Percepção do manejo seguro da distócia, Deconhecimento sobre a gravidade que constitui a hemorragia pós-parto e Incompetência no reparo de traumas perineais. Conclusão As participantes identificaram que a presença da enfermeira obstetra/obstetriz, trouxe segurança para que prosseguissem confiantes no modelo de parto na água. As necessidades das mulheres foram atendidas com respeito permanente pelas profissionais, o que favoreceu a autonomia das puérperas, a harmonia entre as partes e o suporte da enfermeira.

Resumen Objetivo Analizar la comprensión de puérperas sobre la participación de la enfermera obstetra/partera en el parto en el agua, bajo la perspectiva de la teoría del autocuidado. Métodos Estudio cualitativo por medio de la técnica de análisis de contenido, con la participación de 21 mujeres portuguesas que tuvieron su parto en el agua, en ambiente hospitalario. Se utilizó el concepto de autocuidado propuesto por Dorothea Orem como marco referencial teórico. Resultados Surgió una gran categoría "Necesidades de autocuidado en el contexto del parto en el agua", cuyas unidades de significado fueron: Miedo de no poder realizar el parto en el agua, Percepción del manejo seguro de la distocia, Desconocimiento sobre la gravedad que constituye la hemorragia posparto e Incompetencia en la reparación de traumas perineales. Conclusión Las participantes identificaron que la presencia de la enfermera obstetra/partera les dio seguridad para continuar con confianza con el modelo de parto en el agua. Las necesidades de las mujeres fueron atendidas con respeto permanente por parte de las profesionales, lo que favoreció la autonomía de las puérperas, la armonía entre las partes y el apoyo de la enfermera.

Abstract Objective To analyze the puerperal women's understanding about the participation of obstetric nurses/nurse-midwives in water birth, under the light of the Self-Care Deficit Theory. Methods This is a qualitative study using the content analysis technique with the participation of 21 Portuguese women who had water birth at a hospital. The concept of self-care proposed by Dorothea Orem was used as a theoretical framework. Results The mean category "Need for self-care in the context of water birth" emerged, whose meaning units were: Fear of not being able to experience water birth; Perception of dystocia safe management; Lack of knowledge about the severity of postpartum hemorrhage; and Incompetence in perineal trauma repair. Conclusion Participants identified that the presence of obstetric nurses/nurse-midwives brought security for them to continue confident in the water birth model. Women's needs were met with permanent respect by professionals, which favored puerperal women's autonomy, harmony between parties and support by nurses.

Access of people with pulmonary tuberculosis to government programs: Primary Care professionals' perceptions.

OBJECTIVE: to analyze Primary Health Care professionals' perceptions about the access of people with pulmonary tuberculosis to government social support and income transfer programs. METHODS: multicenter/qualitative study, carried out in Family Health Units in four Brazilian capitals: Belém/Pará, Campo Grande/Mato Grosso do Sul, Recife/Pernambuco and Rio de Janeiro/Rio de Janeiro. Fifty-eight professionals participated (social workers, dentists, nurses, pharmacists, physicians and nursing technicians), who provided assistance to people with pulmonary tuberculosis. Individual interviews were conducted, and the content analysis technique was used. RESULTS: among the participants, 45/77.6% were women and 33/56.9% were between 25 and 40 years old. Two thematic categories were organized, demonstrating the perceptions about the possibilities of access to government programs by people with pulmonary tuberculosis in vulnerable situations and the obstacles inherent to this context. FINAL CONSIDERATIONS: it is necessary to move forward in improving patient access to social programs.

Perceção das mulheres sobre os cuidados recebidos durante o parto na água / Women's perceptions of the care received during water birth / Percepción de las mujeres sobre la atención recibida durante el parto en el agua

Resumo Enquadramento: O modelo de cuidados prestados durante o parto na água é interpessoal, integral e respeitado. Objetivo: Conhecer a perceção das mulheres sobre os cuidados recebidos pelas enfermeiras especialistas de saúde materna e obstétrica durante o parto na água na perspetiva da teoria de enfermagem de Jean Watson. Metodologia: Investigação empírica, qualitativa, interpretativa com 24 mulheres portuguesas que vivenciaram o parto na água no hospital ou no domicílio, com tratamento dos dados baseados no método de análise de conteúdo de Bardin. Resultados: A partir das narrativas, emergiram cinco categorias - ambiente acolhedor; a mulher no controlo do seu próprio parto; relação de confiança; expectativas correspondidas e o companheiro como parte do processo. Conclusão: O Processo Clinical Caritas foi percebido nas narrativas através do respeito e do carinho durante os cuidados prestados, proporcionando uma relação e cooperação, que promoveu posteriormente uma cura interior através desse processo de cuidados. A perceção das participantes do estudo quanto aos cuidados recebidos revelou um ambiente seguro, íntimo, respeitado, acolhedor, sem intervenções desnecessárias, favorável e amparado pelo companheiro.

Abstract Background: The model for care provided during water birth is interpersonal, comprehensive, and respected. Objective: To identify women's perceptions of the care provided by nurses specialized in maternal and obstetric health nursing nurses specialized in maternal and obstetric health nursing during water birth from the perspective of Jean Watson's nursing theory. Methodology: Empirical, qualitative, and interpretative research with 24 Portuguese women who had a water birth in hospitals or at home. Data were analyzed using Bardin's content analysis method. Results: Five categories emerged from the narratives: welcoming environment; women in control during labor; trusting relationship; expectations fulfilled; and the partner as part of the process. Conclusion: The Clinical Caritas Process was perceived in the narratives through respect and affection during care delivery to develop a relationship and promote cooperation, leading to inner healing through this care process. Participants' perceptions of the care received during their water birth revealed a safe, intimate, respectful, welcoming, and favorable environment, without unnecessary interventions and supported by the partner.

Resumen Marco contextual: El modelo de atención al parto en el agua es interpersonal, integral y respetado. Objetivo: Conocer la percepción de las mujeres sobre la atención recibida por las enfermeras especializadas en salud materna y obstetricia durante el parto en el agua desde la perspectiva de la teoría de la enfermería de Jean Watson. Metodología: Investigación empírica, cualitativa e interpretativa con 24 mujeres portuguesas que tuvieron un parto en el agua en el hospital o en casa, con un tratamiento de datos basado en el método de análisis de contenido de Bardin. Resultados: De las narrativas surgieron cinco categorías, ambiente acogedor; la mujer en el control de su propio parto; relación de confianza; expectativas cumplidas y la pareja como parte del proceso. Conclusión: El Proceso Clinical Caritas fue percibido en las narrativas a través del respeto y el afecto durante la atención prestada, lo que proporcionó una relación y cooperación, que posteriormente promovió una curación interior a través de este proceso de atención. La percepción de las participantes en el estudio sobre la atención recibida mostró un ambiente seguro, íntimo, respetuoso, acogedor, sin intervenciones innecesarias, favorable y apoyado por la pareja.