Barriers and facilitators to engagement with artificial intelligence (AI)-based chatbots for sexual and reproductive health advice: a qualitative analysis.

Background The emergence of artificial intelligence (AI) provides opportunities for demand management of sexual and reproductive health services. Conversational agents/chatbots are increasingly common, although little is known about how this technology could aid services. This study aimed to identify barriers and facilitators for engagement with sexual health chatbots to advise service developers and related health professionals. Methods In January-June 2020, we conducted face-to-face, semi-structured and online interviews to explore views on sexual health chatbots. Participants were asked to interact with a chatbot, offering advice on sexually transmitted infections (STIs) and relevant services. Participants were UK-based and recruited via social media. Data were recorded, transcribed verbatim and analysed thematically. Results Forty participants (aged 18-50 years; 64% women, 77% heterosexual, 58% white) took part. Many thought chatbots could aid sex education, providing useful information about STIs and sign-posting to sexual health services in a convenient, anonymous and non-judgemental way. Some compared chatbots to health professionals or Internet search engines and perceived this technology as inferior, offering constrained content and interactivity, limiting disclosure of personal information, trust and perceived accuracy of chatbot responses. Conclusions Despite mixed attitudes towards chatbots, this technology was seen as useful for anonymous sex education but less suitable for matters requiring empathy. Chatbots may increase access to clinical services but their effectiveness and safety need to be established. Future research should identify which chatbots designs and functions lead to optimal engagement with this innovation.

Self-Care in Heart Failure Inpatients: What Is the Role of Gender and Pathophysiological Characteristics? A Cross-Sectional Multicentre Study.

Heart failure is often characterised by low exercise capacity and a great impairment of performance in the activities of daily living. The correct management of the disease can prevent the worsening of symptoms and promote a better quality of life. The aims of this study are to understand the relationship of gender and pathophysiological characteristics with self-care behaviour and to evaluate the self-care behaviour in a sample of Portuguese heart failure inpatients, using the Self-Care of Heart Failure Index (SCHFI). A cross-sectional multicentre study enrolling 225 heart failure inpatients from eight hospitals from Portugal was performed. At admission, each patient's functional capacity was evaluated as well as their self-care behaviour, using the SCHFI Portuguese v6.2. A comparison between self-care behaviour with gender was performed. The patients' mean age was 68.4 ± 10.7 years old, 68% were male and 82.3% had reduced ejection fraction. A mean value of 47.9, 35.6 and 38.8 points was found in the SCHFI score of the sections self-care maintenance, self-care management and self-care confidence, respectively. Heart failure inpatients present inadequate levels of self-care behaviour. The results do not suggest a relationship between gender and pathophysiological characteristics with self-care behaviour.

Promoção de comportamentos de saúde na pessoa com doença pulmonar obstrutiva crónica: intervenção de enfermagem comunitária / Promotion of health behaviors in people with chronic obstructive pulmonary disease: community nursing intervention

A Doença Pulmonar Obstrutiva Crónica (DPOC) é uma das doenças crónicas com maior prevalência mundialmente. Adotar comportamentos de saúde como a cessação tabágica, prática de exercício físico e a adequada adesão à medicação permitem a redução da morte prematura, morbilidade e incapacidade, aumentando a qualidade de vida e o bem-estar desta população. Este trabalho de intervenção comunitária decorreu entre 23 de Setembro de 2019 e 07 de Fevereiro de 2020 e teve como objetivo geral capacitar os participantes da amostra para uma adequada gestão da DPOC. Realizado segundo a metodologia do Planeamento em Saúde de Imperatori e Giraldes (1993) e de acordo com o Modelo dos Sistemas de Betty Neuman. Para o Diagnóstico de Situação aplicou-se um instrumento composto por duas partes: questionário sócio-demográfico e Medida de Adesão aos Tratamentos de Delgado e Lima (2001). A amostra foi constituída por um grupo de indivíduos (N=42) com DPOC inscritos na USF AS. O Diagnóstico de Situação permitiu identificar stressores intra-sistema como, o desconhecimento acerca da DPOC, a não identificação como doente do foro respiratório, inadequada gestão da medicação, não abandono de comportamentos de risco (hábitos tabágicos) e falta de exercício físico e stressores extra-sistema relacionados com a acessibilidade aos cuidados de saúde, nomeadamente, inexistência de Consultas de Enfermagem de seguimento da Pessoa com DPOC e Cessação Tabágica na USF AS. As estratégias de intervenção foram a realização de uma sessão de educação para a saúde (individuais e em grupo), a implementação de uma consulta de enfermagem de seguimento da Pessoa com DPOC e a implementação de uma consulta de enfermagem de Cessação Tabágica. A capacitação dos indivíduos torna-os mais conscientes das ações promotoras de saúde, bem como na adequada gestão da doença crónica quando esta já está instalada. Neste sentido, os cuidados de saúde primários e, em especial, a Enfermagem, têm um papel fundamental na promoção de comportamentos de saúde nas populações, tornando indivíduos e grupos capazes de tomar decisões adequadas à sua saúde, de forma responsável e autónoma, com vista à melhoria da sua qualidade de vida.

Chronic Obstructive Pulmonary Disease (COPD) is one of the most prevalent chronic diseases worldwide. Adopting health behaviors, namely smoking cessation, physical exercise and adequate medication adherence, is imperative in the COPD management, contributing to the reduction of premature death, morbidity and disability, in order to increase the quality of life and well-being of this population. This community intervention took place between September 23rd , 2019 and February 7th, 2020 and had the purpose of empowering the participants in the study for an adequate management of COPD. It has been organized according to the Imperatori e Giraldes (1993) Health Planning Method and structured with the assumptions of the Betty Neuman Systems Model. In regard to prepare the Situation Diagnosis, was applied a data collection instrument composed of two parts: a sociodemographic questionnaire and the Measure of Adherence to Treatments by Delgado e Lima (2001). The sample consisted of a group of individuals (N = 42) with the diagnosis of COPD and registered in the USF AS. The Situation Diagnosis allowed to identify intra-system stressors, such as the lack of knowledge about COPD, the lack of identification as a respiratory patient, inadequate medication management, non-abandonment of risk behaviors (smoking habits) and lack of physical exercise and extra-system stressors, related to the access to health care by this population, namely, lack of follow-up nursing consultations for people with COPD and smoking cessation at USF AS. The intervention strategies consisted in health education sessions (individually and group session), the implementation of a follow-up nursing consultation for the person with COPD and the implementation of a smoking cessation nursing consultation. The empowerment of individuals improves their awareness for health-promoting actions, as well as the appropriate management of chronic disease when it is already installed. In this sense, primary health care professionals and, in particular, nursing, have an important role in promoting health behaviors in populations, making individuals and groups capable of making appropiate decisions to their health, in a responsible and autonomous way, in order to improve their quality of life.

Reestruturação da gestão das vigilâncias em saúde em Alagoas: a precarização da formação e do trabalho / Restructuring health surveillance management in Alagoas, Brazil: pracarization of training and labor / Reestructuración de la gestión de las vigilancias en la salud en Alagoas, Brasil: la precarización de la formación y del trabajo

Resumo A descentralização das vigilâncias sanitária, epidemiológica e ambiental para os municípios tomou impulso com mudanças organizacionais e no financiamento federal, quando cresceu a ideia de integração entre elas, e delas com a atenção individual e coletiva. Nos organogramas de muitas secretarias de Saúde, reuniram-se as vigilâncias sob uma coordenação comum, e os gestores demandaram a formação de novos profissionais para esse arranjo. Este artigo objetiva delinear os perfis dos profissionais de nível médio das vigilâncias de seis municípios do estado de Alagoas e dos serviços em que eles operam, agregando percepções dos gestores sobre a prática desses trabalhadores, que representam 88% da força de trabalho das vigilâncias nesses municípios. Sem formação específica para realizar suas atividades, o desempenho dos trabalhadores foi avaliado como pior quanto menor o tempo de exercício do gestor no cargo. As dificuldades destacadas foram: ingerência política no trabalho da vigilância sanitária e ambiental; preenchimento deficiente das fichas de investigação epidemiológica pelas equipes de saúde da família nos seis municípios; papel indefinido desse profissional na vigilância em saúde do trabalhador. A necessária formação técnica é insuficiente para superação dessas dificuldades, requerendo-se a revisão de processos de gestão e coordenação do trabalho das equipes para práticas mais efetivas.

Abstract The decentralization of health, epidemiological, and environmental surveillance at municipalities was driven by organizational changes and changes made to federal funding, and the idea of not only integrating them, but also blending them with individual and collective care, gained momentum. Many health departments’ organization charts brought the different surveillances together under a common coordination, and managers demanded new professionals be trained to meet the needs of this arrangement. This article aims to outline the profile of the middle-level professionals at the surveillances at six municipalities in the state of Alagoas, Brazil, and services they provide, adding the views of the managers about the practices of these workers, who account for 88 percent of the surveillance workforces in these municipalities. With no specific training to carry their activities out, it was noted that the less time the manager had been holding his or her position, the poorer the employees performed. The main difficulties highlighted were political interference in the health and environmental monitoring work; poor filling in of the epidemiological investigation forms by the family health teams in the six municipalities, in addition to these professionals’ undefined roles in worker health surveillance. The required technical training is insufficient to overcome these difficulties, a fact that demands a revision of the teams’ labor management and coordination processes to ensure more effective practices.

Resumen La descentralización de las vigilancias sanitaria, epidemiológica y ambiental para los municipios cobró fuerzas a partir de cambios en la organización y en el financiamiento federal, cuando germinó la idea de la integración entre ellas y de ellas con la atención individual y colectiva. En los organigramas de muchas secretarías de salud, las vigilancias fueron reunidas bajo una coordinación común, y los gestores solicitaron la formación de nuevos profesionales para esa disposición. Este artículo apunta a delinear los perfiles de los profesionales de nivel medio de las vigilancias de seis municipios de Alagoas, Brasil, y de los servicios en los cuales operan, agregando percepciones de los gestores sobre la práctica de esos trabajadores, que representan el 88% de la fuerza de trabajo de las vigilancias en esos municipios. Sin formación específica para realizar sus actividades, el desempeño de los trabajadores fue evaluado como peor cuanto menor el tiempo de ejercicio del gestor en el cargo. Las dificultades destacadas fueron: injerencia política en el trabajo de vigilancia sanitaria y ambiental; cumplimentación deficiente de los formularios de investigación epidemiológica por parte de los equipos de salud de la familia en los seis municipios; e indefinición del rol profesional en la vigilancia en salud del trabajador. La necesaria formación técnica es insuficiente para superar esas dificultades, necesitando la revisión de procesos de gestión y coordinación del trabajo de los equipos para lograr prácticas más efectivas.

Triple Negative Breast Cancer: Nanosolutions for a Big Challenge.

Triple negative breast cancer (TNBC) is a particular immunopathological subtype of breast cancer that lacks expression of estrogen and progesterone receptors (ER/PR) and amplification of the human epidermal growth factor receptor 2 (HER2) gene. Characterized by aggressive and metastatic phenotypes and high rates of relapse, TNBC is the only breast cancer subgroup still lacking effective therapeutic options, thus presenting the worst prognosis. The development of targeted therapies, as well as early diagnosis methods, is vital to ensure an adequate and timely therapeutic intervention in patients with TNBC. This review intends to discuss potentially emerging approaches for the diagnosis and treatment of TNBC patients, with a special focus on nano-based solutions that actively target these particular tumors.

O perfil de competências do trabalhador de nível técnico no campo das vigilâncias / The skills profile of the worker in the field of technical surveillance

Diante da necessidade de implementação do processo de descentralização das vigilâncias, muitos trabalhadores de nível médio vêm sendo transferidos do nível estadual para o municipal, assim como outros vêm sendo contratados pelos municípios para atuarem na estruturação desses serviços. Muitos, sem terem tido acesso à formação específica para atuação na área. Diante da política de desenvolvimento dos trabalhadores do SUS surge a necessidade estratégica de promover a sua educação profissional. A Escola Técnica de Saúde Profª Valéria Hora, responsável pela educação profissional dos trabalhadores de nível médio do SUS, em Alagoas, não tem experiência anterior em formação profissional no campo das vigilâncias. Tal fato motivou esse estudo, que teve como objetivo: delinear o perfil de competências dos trabalhadores de nível técnico do campo das vigilâncias, a partir do conhecimento e análise do processo de trabalho. O estudo foi aplicado em seis municípios selecionados por sorteio, onde se buscou conhecer e interpretar a sua realidade, com o foco nas seguintes categorias de análise: Quem são esses trabalhadores, o que fazem e quais suas dificuldades e necessidades. Foram ouvidos os gestores municipais de saúde em relação às suas percepções e expectativas sobre a prática desses trabalhadores. Observou-se que 85% da força de trabalho que integra o campo das vigilâncias no universo estudado é de pessoal de nível médio, sendo que 100% não tem formação específica. Vêm sendo capacitados através de treinamentos para determinados fazeres, evidenciando uma preparação para atuar em um mero recorte da realidade. Analisando-se os documentos oficiais, observou-se que de forma geral as atribuições definidas para eles, vêm sendo de certa forma realizadas...

In order to face with the implementation the surveillance’s decentralization, many midlevel workers are being moved from the state level to municipal level and others have been hired by municipalities to act in the structuring of those services. Many of them have had no access to general or specific education in the area. From the SUS’ workers political development Law comes the strategic needs to promote vocational education to these workers. However, the Technical School of Health Prof. Valéria Hora, which is responsible for the education of professional-level workers of SUS in the state of Alagoas, has no previous experience in training in the field of surveillance. This fact hasmotivated this study, which has the objective to: outline the skills profile of workers in the technical field of surveillance, based on knowledge and analysis of their work process. It is an exploratory study of qualitative nature, applied in six cities selected by draw, where sought to know and interpret the reality of these workers with a focus inthe following categories of analysis: a) Who are these workers; b) What they do and what are their difficulties and their needs. Were heard also the local health managers, regarding to their perceptions and expectations about the practice of these workers. It was observed that 85% of the workforce that integrates the field of surveillance in the universe studied is mid-level staff, and 100% have no specific training. They have been empowered through training to specific issues, showing a preparation of the worker towork only in a mere detachment from reality. By analyzing the official documents, it was observed that in general the tasks set for these workers, have been carried out. Often without understanding of reality as a whole, without knowing the results of theiractivities and tasks performed as required by their coordinators, setting that in fact they are treated as mere executors of the technical...

Dificuldades de aprendizagem em adultos: a teoria das defasagem cognitivas / Learning difficulty in adult: The cognitive discrepancy theory

O adulto, como sujeito cognitivo, exercendo determinadas estruturas cognitivas em campos específicos, relacionadas às áreas de estudo e de atuação profissional, pode não generalizar algumas dessas estruturas de modo a aplicá-las formalmente a todas as situações-problema com as quais se depara, não conseguindo ultrapassar limites de condutas operatórias concretas, segundo a teoria psicogenética de Piaget. Desse modo, o adulto...(AU)

The adult, as cognitive individual, exercising determinate cognitive structures in specific areas, related to his study area professional activity, he may not generalize some the these structures to adapt them formally to all problematic situations he encounters, not being adle to surpass limits of concrete operative proceedings, according to the psychogenetic theory of Piaget. So, the adult...(AU)

Evaluation of hair fiber hydration by differential scanning calorimetry, gas chromatography, and sensory analysis.

Hair hydration is one of the effects that consumers most expect when using a cosmetic hair product. The purpose of this study was to combine differential scanning calorimetry (DSC) and gas chromatography (GC) techniques for a precise evaluation of the water content in hair fiber. DSC allowed determination of the bonding strength of water to hair fibers by quantifying the amount of energy required to remove the water. The amount of water thus removed was determined by GC. Post-treatment sensory evaluations of hair tresses were conducted to determine whether the values obtained with these techniques correspond to the moisturizing sensation perceived by consumers.

Estudo dos aspectos éticos dos transplantes na América Latina / Study of ethic aspects of transplant in Latin America

Respeitando recomendaçöes da OMS, foi feito estudo retrospectivo comparativo das legislaçöes de 16 Países da América Latina, a saber: Argentina, Bolívia, Brasil, Colômbia, Costa Rica, Chile, Cuba, Equador, Guatemala, Honduras, México, Panamá, Paraguai, Peru, República Dominicana e Venezuela, do período de 1963 a 1992, enfatizando-se os aspectos éticos referentes a doaçäo, determinaçäo da morte, conflito de interesses, seleçäo do receptor, comercializaçäo e intercâmbio internacional de órgäos.

Mucormicose (zigomicose) rino cerebral: apresentaçäo de dois casos com sobrevida / Mucomycosis (zygomycosis) rhinocerebral: report of two cases with prognosis

Säo relatados dois casos de mucormicose rinocerebral em jovens diabéticos. Num paciente, a micose teve curso arrastado e apesar do envolvimento sino-órbito-cerebral, a sintomatologia refletiu apenas o comprometimento órbito-ocular. No outro paciente, a doença teve curso agudo nasal e palatina, seios paranasais, tecidos periorbitários, olho e nervos cranianos, porém sem acometimento cerebral. Houve sobrevida de ambos os pacientes, porém, em apenas um deles o diagnóstico foi completo pelo isolamento do agente