Experiences of family members of cancer patients in palliative care: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to synthesize the experiences of family members of cancer patients in palliative care. INTRODUCTION: Increasingly, palliative care is the approach advocated when a life-threatening illness has been diagnosed. Cancer patients and their families, when receiving early identification, correct assessment, and treatment of pain and other problems through palliative care, report feeling supported in their illness experience. The patients and their families also describe immediate and personalized symptom management, holistic support, decision-making guidance, and preparation for the future, including the dying process and stages of grief. A growing number of studies address palliative care patients and, in particular, the central role of family in this approach. This review will synthesize qualitative research on this subject, providing recommendations to health professionals to help them better understand the experiences and needs of family members of cancer patients receiving palliative care. INCLUSION CRITERIA: The review will consider studies examining experiences of families of cancer patients in palliative care, in all types of settings and contexts. The studies will focus on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, qualitative descriptive, and mixed methods studies. METHODS: The review will follow the JBI methodology for systematic reviews of qualitative evidence. The search strategy will aim to locate both published and unpublished studies, in any language, with no date restrictions. Methodological quality will be evaluated using the standard JBI critical appraisal checklist for qualitative research. The findings will be pooled using the meta-aggregation approach or will be presented in narrative format. The final synthesized findings will be graded according to the ConQual approach. REVIEW REGISTRATION: PROSPERO CRD42022333937.

Knowledge of Brazilian dentists about bisphosphonate-associated osteonecrosis of the jaw / Conhecimento de dentistas brasileiros sobre a osteonecrose dos maxilares associada ao uso de bisfosfonatos

Osteonecrosis of the jaw associated with bisphosphonate use is a matter of utmost importance in clinical practice for the safe treatment of patients using this medication. Objective: The aim of this study was to evaluate the level of knowledge of dentists who carry out clinical practice about bisphosphonate-associated jaw osteonecrosis. Material and Methods: The methodology used in the present research consisted of a non-probability sampling approach for the selection of participants. To conduct the study, a questionnaire created on the Google Forms platform was sent via Direct on Instagram to the professionals who agreed to participate. The data were sent for analysis, using the frequency for each response, and the professionals were divided into subcategories according to their time of professional practice. Results: Participants were familiar with the purpose of the medication (65%) or had heard of it (34%); regarding the professionals' opinion on their knowledge and practice about bisphosphonate-related osteonecrosis a significant percentage (93.24%) responded positively regarding the existence of side effects resulting from the therapeutic use of bisphosphonates and 48.65% self-evaluated their level of knowledge on the subject as insufficient. Conclusion: The study reveals that almost all participating dentists have good knowledge about the effects caused by bisphosphonates, but some of them still do not feel specifically confident about the management and knowledge of jaw osteonecrosis (AU)

A osteonecrose dos maxilares associada ao uso de bisfosfonatos é um assunto de suma importância na prática clínica para o atendimento seguro dos pacientes que fazem uso terapêutico do medicamento. Objetivo: O objetivo deste trabalho foi avaliar o nível de conhecimento de cirurgiões dentistas que realizam atendimento clínico acerca da osteonecrose dos maxilares associada ao uso dos bisfosfonatos. Material e Métodos: A metodologia utilizada na presente pesquisa consistiu em uma abordagem de amostragem não probabilística para a seleção dos participantes. Para conduzir o estudo, enviamos um questionário criado na plataforma Google Forms via Direct no Instagram para os profissionais que concordaram em participar. Os dados foram enviados para análise, usando a frequência para cada resposta, sendo que os profissionais foram divididos em subcategorias por tempo de formação. Resultados: Os participantes estavam familiarizados com a finalidade do medicamento (65%) ou já haviam ouvido falar deles (34%); em relação à opinião dos profissionais sobre seu conhecimento e prática acerca da osteonecrose relacionada aos bisfosfonatos, observou-se que 48,65% autoavaliaram seu nível de conhecimento sobre o assunto como insuficiente e uma parcela expressiva (93,24%) respondeu positivamente em relação à existência de efeitos colaterais decorrentes ao uso terapêutico dos bisfosfonatos. Conclusão: O estudo revela que quase todos os dentistas participantes possuem um bom conhecimento acerca dos efeitos causados pelos bisfosfonatos, mas que parte deles ainda não se sentem seguros especificamente em relação ao manejo e conhecimento da osteonecrose dos maxilares (AU)

Peripheral isolation and demographic stability are reflected in the genetic diversity of the populations of the Helmeted Manakin: a bird endemic to the gallery forests.

The Cerrado encompasses a complex network of hydrographic basins, which is responsible for the formation and maintenance of the riparian and gallery forests. Alterations in the vegetation resulting from the paleoclimatic changes that occurred during the Pleistocene influenced the current distribution of these humid forests. To understand of the evolutionary dynamics of this landscape on the population structure of the associated organisms, we studied the population genetics of the Antilophia galeata (Pipridae), a bird endemic to the gallery forests of the Cerrado. For this, we evaluated the variability of the mitochondrial control region of 71 A. galeata specimens from 18 localities distributed throughout the Cerrado. The results indicated the existence of significant substructure among the populations located in the peripheral areas of the Cerrado, in comparison with the populations found in the central portion, reflecting historical changes in the environment. We also found high levels of diversity in all the populations, while the analysis of the demographic history revealed a scenario of stability. Overall, then, these findings indicate that the historical modifications of the gallery forest distribution may have been most accentuated in the peripheral zones, with a greater stability and connectivity persisting in the central portion of the biome.

Recent chapters of Neotropical history overlooked in phylogeography: Shallow divergence explains phenotype and genotype uncoupling in Antilophia manakins.

Establishing links between phenotypic and genotypic variation is a central goal of evolutionary biology, as they might provide important insights into evolutionary processes shaping genetic and species diversity in nature. One of the more intriguing possibilities is when no genetic divergence is found to be associated with conspicuous phenotypic divergence. In that case, speciation theory predicts that phenotypic divergence may still occur in the presence of significant gene flow-thereby resulting in little genomic divergence-when genetic loci underpinning phenotypes are under strong divergent selection. However, a finding of phenotypic distinctiveness with weak or no population genetic structure may simply result from low statistical power to detect shallow genetic divergences when small data sets are used. Here, we used a subgenomic data set of 2,386 ultraconserved elements to explore genomewide divergence between two species of Antilophia manakins, which are phenotypically distinct yet evidently lack strong genetic differentiation according to previous studies based on a limited number of loci. Our results revealed clear population structure that matches the two phenotypes, supporting the idea that smaller data sets lacked the power to detect this recent divergence event (likely <100 k ya). Indeed, we found little or no introgression between the species, as well as evidence of genomewide divergence. One implication of our study is that the Araripe plateau may be a hot spot of cryptic-diverging forest Cerrado populations. Besides their use in biogeography, subgenomic data sets may help redefine local conservation programmes by revealing cryptic population structure that may be key to population management.

Bone mineral density in cone beam computed tomography: Only a few shades of gray.

Cone beam computed tomography (CBCT) has often been used to determine the quality of craniofacial bone structures through the determination of mineral density, which is based on gray scales of the images obtained. However, there is no consensus regarding the accuracy of the determination of the gray scales in these exams. This study aims to provide a literature review concerning the reliability of CBCT to determine bone mineral density. The gray values obtained with CBCT show a linear relationship with the attenuation coefficients of the materials, Hounsfield Units values obtained with medical computed tomography, and density values from dual energy X-ray absorciometry. However, errors are expected when CBCT images are used to define the quality of the scanned structures because these images show inconsistencies and arbitrariness in the gray values, particularly when related to abrupt change in the density of the object, X-ray beam hardening effect, scattered radiation, projection data discontinuity-related effect, differences between CBCT devices, changes in the volume of the field of view (FOV), and changes in the relationships of size and position between the FOV and the object evaluated. A few methods of mathematical correction of the gray scales in CBCT have been proposed; however, they do not generate consistent values that are independent of the devices and their configurations or of the scanned objects. Thus, CBCT should not be considered the examination of choice for the determination of bone and soft tissue mineral density at the current stage, particularly when values obtained are to be compared to predetermined standard values. Comparisons between symmetrically positioned structures inside the FOV and in relation to the exomass of the object, as it occurs with the right and left sides of the skull, seem to be viable because the effects on the gray scale in the regions of interest are the same.

Capacitação em saúde bucal de agentes comunitários da cidade de Juiz de Fora-MG / Training in oral health community agents in Juiz de Fora, MG: the effectiveness of the program

O objetivo do trabalho foi avaliar conhecimentos e atitudes sobre a promoção da saúde bucal dos Agentes Comunitários de Saúde (ACS). Por meio de um estudo transversal, com aplicação de questionário estruturado, cujo público alvo compreendia uma amostra ACS das equipes de Unidades Primárias de Saúde, escolhidas por conveniência, em Juiz de Fora (MG). Mulheres entre 30-50 anos prevaleceram. Os agentes relataram que receberam algum tipo de capacitação em saúde bucal. Verificou-se que 30,8% atuam a mais de 10 anos como agente comunitário de saúde, 33,3 % dos ACS relataram que possuem muita dificuldade em realizar o conjunto de suas atribuições, inclusive no tocante à saúde bucal. Quanto à orientação sobre saúde bucal para as gestantes acerca da realização de escovação supervisionada, 64,1 % responderam que não realizam. A respeito de aplicação de flúor quase a totalidade não a realiza (94,9%). Em relação à cárie e doença periodontal, demonstraram não saber sua etiologia. Acerca do conhecimento sobre saúde bucal de gestantes e bebês, 87,2% afirmaram que as gestantes podem ser submetidas à consulta odontológica; 71,8% responderam que a primeira visita do bebê ao CD deve ser feita no 1° ano de vida. Conclui-se que houve uma alta prevalência de ACS leigos em relação à temática saúde bucal. Ao mesmo tempo pode-se afirmar que, na maioria dos casos, o conhecimento prévio dos ACS sobre o tema abordado está relacionado ao cotidiano dos mesmos e não por uma orientação formal, demonstrado a necessidade de uma capacitação. Sendo o acompanhamento do Cirurgião-dentista da unidade nas atividades desenvolvidas pelas ACS, o que torna processo de promoção em saúde bucal mais efetivo, permanente e eficaz.