Encapsulated Mesenchymal Stromal Cells as Cyclic Providers of Immunomodulatory Secretomes: A Living on-Demand Delivery System.

The stimulation of mesenchymal stromal cells (MSCs) with inflammatory molecules is often used to boost their therapeutic effect. Prolonged exposure to inflammatory molecules has been explored to improve their action because MSCs therapies seem to be improved transiently with such stimuli. However, the possibility of cyclically stimulating MSCs to recover their optimized therapeutic potential is still to be elucidated, although the efficacy of cell-based therapies may be dependent on the ability to readapt to the relapse pathological conditions. Here, the response of MSCs, encapsulated in alginate hydrogels and cultured for 22 d, is explored using three different regimes: single, continuous, and intermittent stimulation with IFNγ. Exposure to IFNγ leads to a decrease in the secretion of IL-10, which is cyclically countered by IFNγ weaning. Conditioned media collected at different stages of pulsatile stimulation show an immunomodulatory potential toward macrophages, which directly correlates with IL-10 concentration in media. To understand whether the correlation between cyclic stimulation of MSCs and other biological actions can be observed, the effect on endothelial cells is studied, showcasing an overall modest influence on tube formation. Overall, the results describe the response of encapsulated MSCs to unusual pulsatile simulation regimens, exploring encapsulated MSCs as a living on-demand release system of tailored secretomes with recoverable immunomodulatory action.

Medical residency in Portugal: a cross-sectional study on the working conditions.

Objectives: The current European crisis in human resources in health has opened the debate about working conditions and fair wages. This is the case with Resident doctors, which have faced challenges throughout Europe. In Portugal, they account for about a third of the doctors in the Portuguese National Health Service. No studies to date objectively demonstrate the working conditions and responsibilities undertaken. This study aims to quantify the residents' workload and working conditions. Methods: Observational, retrospective cross-sectional study which involved a survey on the clinical and training activity of Portuguese residents, actively working in September 2020. The survey was distributed through e-mail to residents' representatives and directly to those affiliated with the Independent Union of Portuguese Doctors. The descriptive analysis assessed current workload, and logistic regression models analyzed associations with geographical location and residency seniority. Results: There were a total of 2,012 participants (19.6% of invited residents). Of the residents giving consultations, 85.3% do so with full autonomy. In the emergency department, 32.1% of the residents work 24 h shifts and 25.1% work shifts without a specialist doctor present. Regarding medical training, 40.8% invest over EUR 1,500 annually. Autonomy in consultations was associated with being a Family Medicine resident (OR 4.219, p < 0.001), being a senior resident (OR 5.143, p < 0.001), and working in the Center (OR 1.685, p = 0.009) and South regions (OR 2.172, p < 0.001). Seniority was also associated with investing over EUR 1,500 in training annually (OR 1.235, p = 0.021). Conclusion: Residents work far more than the contracted 40 h week, often on an unpaid basis. They present a high degree of autonomy in their practice, make a very significant personal and financial investment in medical training, with almost no time dedicated to studying during working hours. There is a need to provide better working conditions for health professionals, including residents, for the sake of the sustainability of health systems across Europe.

Chest wall perforator flaps for partial breast reconstruction after conservative surgery: Prospective analysis of safety and reliability.

INTRODUCTION: Breast-conserving surgery associated with adjuvant radiotherapy is the state of the art in the surgical treatment of breast cancer. Oncoplastic surgery through dermo-adipose flaps based in perforating arteries (muscle sparing flaps) for partial reconstruction is increasingly used as a good option for avoiding musculocutaneous flaps. In this study we evaluate the outcomes of the use of chest wall perforator flaps in the replacement of partial breast volume. METHODS: A prospective cohort study of female patients that underwent a conservative oncoplastic surgery procedure with partial breast reconstruction using a dermo-adipose flap of perforating arteries of the chest wall was conducted between November 2020 and March 2022 at our centre. Primary outcomes were surgical morbidity, positive margins and reoperation rates. Characteristics associated with the occurrence of complications were further identified. RESULTS: Forty-five patients underwent the procedure of interest during the study period. The mean age was 55 years. The median larger dimension of the tumor was 23 mm. Lateral intercostal artery perforator (LICAP), lateral thoracic artery perforator (LTAP), a combined flap and Anterior Intercostal Artery Perforator/Medial Intercostal Artery Perforator (AICAP)/(MICAP) were performed in 22, 16, 2 and 5 patients, respectively. The mean operative time was 126 min. A total of 9 (20.0%) patients required a reoperation after definitive diagnosis, 4 due to positive margins and 5 due to immediate/early surgical morbidity. CONCLUSIONS: Local perforator flaps in oncoplastic breast-conserving surgery are a good option for immediate reconstruction after conservative surgery, showing low morbidity and favourable outcomes.

Controlling the Structure and Morphology of Organic Nanofilaments Using External Stimuli.

In our continuing pursuit to generate, understand, and control the morphology of organic nanofilaments formed by molecules with a bent molecular shape, we here report on two bent-core molecules specifically designed to permit a phase or morphology change upon exposure to an applied electric field or irradiation with UV light. To trigger a response to an applied electric field, conformationally rigid chiral (S,S)-2,3-difluorooctyloxy side chains were introduced, and to cause a response to UV light, an azobenzene core was incorporated into one of the arms of the rigid bent core. The phase behavior as well as structure and morphology of the formed phases and nanofilaments were analyzed using differential scanning calorimetry, cross-polarized optical microscopy, circular dichroism spectropolarimetry, scanning and transmission electron microscopy, UV-vis spectrophotometry, as well as X-ray diffraction experiments. Both bent-core molecules were characterized by the coexistence of two nanoscale morphologies, specifically helical nanofilaments (HNFs) and layered nanocylinders, prior to exposure to an external stimulus and independent of the cooling rate from the isotropic liquid. The application of an electric field triggers the disappearance of crystalline nanofilaments and instead leads to the formation of a tilted smectic liquid crystal phase for the material featuring chiral difluorinated side chains, whereas irradiation with UV light results in the disappearance of the nanocylinders and the sole formation of HNFs for the azobenzene-containing material. Combined results of this experimental study reveal that in addition to controlling the rate of cooling, applied electric fields and UV irradiation can be used to expand the toolkit for structural and morphological control of suitably designed bent-core molecule-based structures at the nanoscale.

Transsexuality and health demands: representations of nursing students.

OBJECTIVE: To analyze the social representations of nursing students about transsexuality and the health demands of transsexual people. METHODS: Qualitative, descriptive research with undergraduate nursing students from a public university in Rio de Janeiro/Brazil. The data came from a semi-structured interview and lexical analysis using Alceste 2012 software. RESULTS: Transsexuality was represented as a transgression, with the transsexual person being objectified as unnatural because they do not identify with their biological sex. Hormone therapy and sex reassignment surgeries were understood as the main demands, being anchored in a pathologizing and medicalizing health sphere. However, the theme is not addressed during graduation, generating unpreparedness for professional life. FINAL CONSIDERATIONS: The need to update the academic curriculum, as well as the way of thinking about the care of transsexual people, is essential and urgent for an integral and equitable care.

Chirality Transfer from an Innately Chiral Nanocrystal Core to a Nematic Liquid Crystal 2: Lyotropic Chromonic Liquid Crystals.

The importance of and the difference between molecular versus structural core chirality of substances that form nanomaterials, and their ability to transmit and amplify their chirality to and within a surrounding condensed medium is yet to be exactly understood. Here we demonstrate that neat as well as disodium cromoglycate (DSCG) surface-modified cellulose nanocrystals (CNCs) with both molecular and morphological core chirality can induce homochirality in racemic nematic lyotropic chromonic liquid crystal (rac-N-LCLC) tactoids. In comparison to the parent chiral organic building blocks, D-glucose, endowed only with molecular chirality, both CNCs showed a superior chirality transfer ability. Here, particularly the structurally compatible DSCG-modified CNCs prove to be highly effective since the surface DSCG moieties can insert into the DSCG stacks that constitute the racemic tactoids. Overall, this presents a highly efficient pathway for chiral induction in an aqueous medium and thus for understanding the origins of biological homochirality in a suitable experimental system.

Transsexuality and health demands: representations of nursing students / Transexualidad y demandas de salud: representaciones de estudiantes de enfermería / Transexualidade e demandas de saúde: representações de graduandos de Enfermagem

ABSTRACT Objective: To analyze the social representations of nursing students about transsexuality and the health demands of transsexual people. Methods: Qualitative, descriptive research with undergraduate nursing students from a public university in Rio de Janeiro/Brazil. The data came from a semi-structured interview and lexical analysis using Alceste 2012 software. Results: Transsexuality was represented as a transgression, with the transsexual person being objectified as unnatural because they do not identify with their biological sex. Hormone therapy and sex reassignment surgeries were understood as the main demands, being anchored in a pathologizing and medicalizing health sphere. However, the theme is not addressed during graduation, generating unpreparedness for professional life. Final considerations: The need to update the academic curriculum, as well as the way of thinking about the care of transsexual people, is essential and urgent for an integral and equitable care.

RESUMEN Objetivo: Analizar las representaciones sociales de estudiantes de enfermería sobre la transexualidad y las demandas de salud de las personas transexuales. Métodos: Investigación cualitativa, descriptiva con estudiantes de graduación en enfermería de una universidad pública de Río de Janeiro/Brasil. Los datos provinieron de una entrevista semiestructurada y análisis léxico utilizando el software Alceste 2012. Resultados: La transexualidad fue representada como una transgresión, siendo objetivada la persona transexual como antinatural porque no se identifica con su sexo biológico. La terapia hormonal y las cirugías de reasignación de sexo fueron entendidas como las principales demandas, ancladas en un ámbito patologizante. ymedicalizando la salud. Sin embargo, el tema no es abordado durante la graduación, generando despreparación para la vida profesional. Consideraciones finales: La necesidad de actualizar el currículo académico, así como la forma de pensar la atención a las personas transexuales, es fundamental y urgente para una atención integral y equitativa.

RESUMO Objetivo: Analisar as representações sociais dos graduandos de enfermagem acerca da transexualidade e as demandas de saúde das pessoas transexuais. Métodos: Pesquisa qualitativa, descritiva, com 28 graduandos em enfermagem de uma universidade pública do Rio de Janeiro/Brasil. Realizou-se uma entrevista semiestruturada, no período de novembro de 2017 a março de 2018, e análise tipo lexical com auxílio do software Alceste 2012. Resultados: A transexualidade foi representada como uma transgressão, sendo a pessoa transexual objetivada como antinatural por não se identificar com seu sexo biológico. Terapia hormonal e cirurgias de redesignação sexual foram entendidas como as principais demandas, sendo ancoradas numa esfera patologizante e medicalizadora da saúde. A temática não é abordada durante a graduação, gerando despreparo para vida profissional. Considerações finais: Faz-se necessário ampliar as discussões sobre gênero na academia, tendo como propósito a transposição do imperativo da heteronormatividade, para que futuros enfermeiros estejam aparelhados para fornecer um cuidado integral e equânime.

An Overview on Radiation Sensitivity in Hereditary Breast and Ovarian Cancer Syndrome.

Hereditary breast and ovarian cancer (HBOC) syndrome is a condition in which individuals have an increased risk of developing different types of cancer when compared to the general population. BRCA1 repair associated (BRCA1) and BRCA2 repair associated (BRCA2) genes are tumor suppressor genes that play a crucial role in cell, by repairing DNA damage. Mutations in these genes are responsible for 25% of HBOC cases. Individuals with this syndrome are often subjected to diagnostic imaging techniques, as well as therapeutic options, that use ionizing radiation, so it is crucial to understand whether these individuals may present higher radiosensitivity and, therefore, its consequences. Several studies have been carried out to understand if the exposure to different ionizing radiation doses can induce cancer in individuals with HBOC. Some of these studies have shown that individuals with HBOC are hypersensitive to the ionizing radiation and, therefore, have neoplasms resulting from mutations in genes that are important in maintaining genomic stability. When mutated, genes no longer guarantee this stability and promote the induction of carcinogenesis. Oppositely, other studies show that there is no association between exposure to ionizing radiation and an increased risk of developing cancer. Thus, the results are inconsistent, and there is a great need to clarify this relationship. In this review, we present the characteristics of HBOC syndrome and the effects that ionizing radiation can induce in individuals who have it. In addition, we review the studies that have already been carried out on this subject.

Musculoskeletal manifestations in a Portuguese cohort of 235 inflammatory bowel disease patients.

BACKGROUND: Musculoskeletal symptoms represent the most common extraintestinal manifestations of inflammatory bowel disease (IBD) and a major cause of impaired quality of life in these patients. Spondyloarthritis (SpA) is classically associated with IBD, but other rheumatic manifestations may occur. OBJECTIVE: To characterize musculoskeletal symptoms and rheumatic diseases in an IBD cohort. METHODS: Retrospective monocentric descriptive study including all the patients with IBD consecutively referred from Gastroenterology to the Reumatology Department (from January of 2013 to April of 2021) in a Portuguese tertiary university hospital. Demographic and clinical data were collected and musculoskeletal symptoms and rheumatic diseases diagnosed in the Rheumatology outpatient center were registered. RESULTS: A total of 235 patients were included: 177 (75.3%) with Crohn´s disease (CD) and 58 (24.7%) with ulcerative colitis. Musculoskeletal symptoms were observed in 142 (60.4%) patients and 105 (44.7%) had some rheumatic condition. Regarding spondyloarthritis, 46 (19.6%) patients fulfilled ASAS (Assessment of SpondyloArthritis international Society) criteria for axial SpA and 5 (2.1%) for peripheral SpA. Osteoarthritis (n=70, 29.8%) and osteoporosis (n=33, 14%) were the most frequent non-inflammatory rheumatic conditions observed, mostly previously undiagnosed. No significant differences were observed between CD and UC. CONCLUSION: Rheumatic conditions are frequent in IBD patients and are not limited to SpA features. They remain mostly undiagnosed and the collaboration between gastroenterologists and rheumatologists is important for their best management.

Social support networks for women in situation of intimate partner violence.

OBJECTIVES: to analyze the possibilities of support that the social support network offers to women in situations of intimate partner violence. METHODS: qualitative research anchored in Sanicola's social network framework. A total of 21 women attended at a specialized social assistance service in Porto Velho-Rondônia, Brazil, participated in a semi-structured interview. RESULTS: the analysis of network maps showed that the secondary social support network mobilized had a central character in the lives of women in situations of violence. These women sought the third sector's secondary network, the churches, from which they received emotional-affective and spiritual support. FINAL CONSIDERATIONS: understanding the social network setting and the type of support offered can contribute to improving care for women and strengthening interpersonal and institutional ties that help in the search for breaking the situation of violence.

Well-Defined Polyethylene Glycol Microscale Hydrogel Blocks Containing Gold Nanorods for Dual Photothermal and Chemotherapeutic Therapy.

Local drug delivery offers a means of achieving a high concentration of therapeutic agents directly at the tumor site, whilst minimizing systemic toxicity. For heterogenous cancers such as glioblastoma, multimodal therapeutic approaches hold promise for better efficacy. Herein, we aimed to create a well-defined and reproducible drug delivery system that also incorporates gold nanorods for photothermal therapy. Solvent-assisted micromolding was used to create uniform sacrificial templates in which microscale hydrogels were formed with and without gold nanorods throughout their structure. The microscale hydrogels could be loaded with doxorubicin, releasing it over a period of one week, causing toxicity to glioma cells. Since these microscale hydrogels were designed for direct intratumoral injection, therefore bypassing the blood-brain barrier, the highly potent breast cancer therapeutic doxorubicin was repurposed for use in this study. By contrast, the unloaded hydrogels were well tolerated, without decreasing cell viability. Irradiation with near-infrared light caused heating of the hydrogels, showing that if concentrated at an injection site, these hydrogels maybe able to cause anticancer activity through two separate mechanisms.

Stress pós-traumático e comorbilidades em profissionais de saúde após infeção pelo SARS-CoV-2 / Post-traumatic stress and comorbidities in healthcare professionals after sars-cov-2 infection

O presente estudo é subordinado ao tema "Stress pós-traumático e comorbilidades em profissionais de saúde após infeção pelo SARS-CoV-2.". A pandemia COVID-19 tem o potencial de ser considerada um evento traumático em massa com um impacto sem precedentes na saúde mental das pessoas. Os profissionais de saúde, estando na linha da frente contra a pandemia, foram o grupo que mais esteve sujeito às consequências da COVID-19. A realidade vivida diariamente no local de trabalho deve ser alvo de atenção: pelo aumento do stress provocado pelo constante risco de infeção e pela falta de equipamento de proteção individual em muitas instituições; pelo aumento da carga de trabalho e mortes associadas; pelo estigma social que advém do fato de contactarem no seu local de trabalho com pessoas diagnosticadas com COVID-19. Com base na experiência retirada de surtos anteriores, as pessoas afetadas apresentaram elevados níveis de stress pós-traumático, nomeadamente os que tiveram de cumprir quarentena ou que trabalharam em serviços com elevado risco de contágio. Assim, assume-se a atual pandemia como fator de risco para o desenvolvimento de problemas de saúde mental, como a Perturbação de Stress Pós-traumático (PSPT). Contudo, algumas pessoas que vivenciam acontecimentos adversos conseguem crescer com a experiência retirada, denominando-se: crescimento pós-traumático. Compreendendo o impacto psicológico da COVID-19 entre os profissionais de saúde é crucial a criação de políticas e intervenções que garantam o seu bem-estar. Com base nos objetivos da investigação e pressupostos metodológicos, pretendeu-se estudar em que medida a ocorrência de diagnóstico de stress pós-traumático e o posterior crescimento pós-traumático nos profissionais de saúde podem variar de acordo com o tipo de isolamento a que estiveram sujeitos e a presença de comorbilidades pré-existentes à infeção pelo SARS-CoV-2. Este estudo enquadra-se no paradigma quantitativo e consiste num estudo do tipo descritivo, correlacional e transversal. A amostra é constituída por 298 profissionais de saúde que cumpriram isolamento profilático ou por infeção por SARS-CoV-2. O método de seleção dos participantes foi realizado através de técnica de amostragem não probabilística. A recolha de dados foi realizada através de um questionário sociodemográfico, do Inventário de Crescimento Pós-traumático (PTGI) e do Inventário de Sintomas Psicopatológicos (BSI). Não se verificou evidência da relação entre a existência de comorbilidade e o diagnóstico de stress pós-traumático. Estudou-se especificamente a associação entre a existência de comorbilidade e as diferentes dimensões da sintomatologia psiquiátrica do BSI, verificando-se relação estatisticamente significativa, sendo a ideação paranóide, obsessão-compulsão e hostilidade aquelas que apresentaram valores mais elevados. O estudo demonstrou relação estatisticamente significativa entre as dimensões do PTGI e a existência de comorbilidade, com exceção da dimensão "desenvolvimento espiritual". Os dados obtidos revelam relação estatisticamente significativa entre o diagnóstico de stress pós-traumático e as dimensões do PTGI. A análise das correlações entre as quatro dimensões do PTGI e o suporte social de familiares e amigos durante o isolamento foi estatisticamente significativa, bem como a análise das correlações entre as quatro dimensões do PTGI e o suporte prestado pelos serviços de saúde durante o isolamento. A correlação das dimensões do PTGI entre si, foi estatisticamente significativa

This study is about the topic "Post-traumatic stress and comorbidities in healthcare professionals due to SARS-CoV-2 infection.". The COVID-19 pandemic has the potential to be considered a mass traumatic event with an unprecedented impact on people's mental health. Healthcare professionals, have been on the front line against the pandemic, becoming a vulnerable group to the consequences of COVID-19. The reality experienced daily, at work, must be considered: due to the increase in stress caused by the constant risk of infection and the lack of personal protective equipment in many institutions; by the increased workload and related deaths; by the social stigma from having contact with patients diagnosed with COVID-19 in their workplaces. Based on experience drawn from previous outbreaks, people affected had higher levels of post-traumatic stress, specially those who had been in quarantine or who worked in services with a high infectio risk. Therefore, the current pandemic is a risk factor for the development of mental health problems, such as Post-traumatic Stress Disorder (PTSD). However, some people who have experienced adverse events are able to grow with a their experiences, we call it post-traumatic growth. Understanding the psychological impact of COVID-19 among healthcare professionals is crucial to create policies and interventions to guarantee their well-being. Based on the research objectives and methodological assumptions, the aim was to study how the occurrence of posttraumatic stress diagnosis and the subsequent post-traumatic growth in healthcare professionals may vary according to the type of quarantine to which they were subjected and the presence of pre-existing comorbidities to SARS-CoV-2 infection. This is a quantitative, descriptive, correlational and cross-sectional study. The sampleconsists of 298 healthcare professionals which had been in quarantine, either prophilatic or isolation due to SARS-CoV-2 infection. This study adopted snowball sampling and online sociodemographic survey, Post-traumatic Growth Inventory (PTGI) and Brief Symptom Inventory (BSI). There is no evidence of statistical significance between the existence of comorbidity and post-traumatic stress. An association between the existence of comorbidity and the different BSI dimensions was specifically analized, verifying a statistically significant relationship, with paranoid ideation, obsession-compulsion and hostility having the higher levels. There was statistical significance between PTGI dimensions and the existence of comorbidity, with the exception of the dimension "spiritual development". There was statistical significance between post-traumatic stress disorder and the PTGI dimensions. Analyzing correlation between the four PTGI dimensions and the social support from relatives and friends during quarantine was statistically significant, as well as the correlation between the four PTGI dimensions and the support provided by health services during quarantine. The correlation of the PTGI dimensions between each other was also statistically significant.

Effects of demographic and clinical character on differences in self-care behavior levels with arteriovenous fistula by hemodialysis patients: An ordinal logistic regression approach.

INTRODUCTION: Hemodialysis (HD) patients should be trained to develop self-care behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients. METHODS: A cross-sectional study was conducted involving 89 patients. RESULTS: Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. CONCLUSION: Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well.

Effects of shape and solute-solvent compatibility on the efficacy of chirality transfer: Nanoshapes in nematics.

Chirality, as a concept, is well understood at most length scales. However, quantitative models predicting the efficacy of the transmission of chirality across length scales are lacking. We propose here a modus operandi for a chiral nanoshape solute in an achiral nematic liquid crystal host showing that that chirality transfer may be understood by unusually simple geometric considerations. This mechanism is based on the product of a pseudoscalar chirality indicator and of a geometric shape compatibility factor based on the two-dimensional isoperimetric quotients for each nanoshape solute. The model is tested on an experimental set of precisely engineered gold nanoshapes. These libraries of calculated and in-parallel acquired experimental data among related nanoshapes pave the way for predictive calculations of chirality transfer in nanoscale, macromolecular, and biological systems, from designing chiral discriminators and enantioselective catalysts to developing chiral metamaterials and understanding nature's innate ability to transfer homochirality across length scales.

Educational Programs and Sexual Counselling for Postmenopausal Sexual Dysfunction: A Systematic Review and Meta-Analysis.

BACKGROUND: Female sexual dysfunction has a high prevalence in women in the postmenopausal period. Not only factors like comorbidities and chronic illnesses are responsible for this high prevalence, but also psychological and interpersonal factors play a significant role. Sexual counselling educational programs have shown positive sexual behavioral changes and they should be considered the first line approach to female sexual dysfunction in this group of women. AIM: To review the evidence of the efficacy of sexual counselling educational programs for sexual dysfunction in postmenopausal women. METHODS: A systematic search was performed in February 2021 from electronic databases (MEDLINE, CENTRAL, and Scopus), unpublished studies, ongoing clinical trials, conference abstracts and journal archives, dissertations and theses, gray literature and free search on the Google Scholar search engine. Studies that evaluate the effectiveness of sexual educational programs in postmenopausal women were selected. Study selection and data extraction were performed by 2 independent researchers. Extracted data included author identification, publication date, geographic location, study population and sample size, type of intervention, sexual function evaluation tool and outcome. Studies that evaluate sexual function by using the Female Sexual Function Index (FSFI) were included in the meta-analysis, calculating the mean difference. OUTCOMES: Improvement of sexual function in postmenopausal women. RESULTS: We included 8 studies in the systematic review, 6 randomized and 2 nonrandomized controlled trials, with a total sample size of 619 women, aged between 39 and 75 years old, all in menopause for less than 5 years. The studies described sexual education programs, with 4-10 sessions, 45-60 minutes each, including themes like sexual anatomy, physiological sexual response, menopause, methods of stimulation, and common sexual myths. Five studies also included cognitive-behavior therapy and 3 studies assessed mindfulness techniques. Six studies evaluated the effectiveness of sexual educational programs using FSFI. The results showed that sexual counselling educational programs had statistically significant effects on enhancing the total FSFI score (mean difference = +7.14, 95% confidence interval = 3.70-10.6, P < .0001) in comparison to routine care. Results were also significant in all evaluated sex domains: pain, arousal, lubrication, desire, orgasm and satisfaction (P < .05). CONCLUSION: Our meta-analysis shows that sexual counselling educational programs are effective in improving sexual dysfunction in postmenopausal women when compared to routine care. These are simple approaches, easily administered with minimal resources that help prevent the psychological and social consequences of sexual dysfunction at this age. IMS Silva, MP Pinto, D Gonçalves. Educational Programs and Sexual Counselling for Postmenopausal Sexual Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2022;19:54-63.

Social support networks for women in situation of intimate partner violence / Redes sociales de apoyo a mujeres en situación de violencia de pareja / Redes de apoio social às mulheres em situação de violência por parceiro íntimo

ABSTRACT Objectives: to analyze the possibilities of support that the social support network offers to women in situations of intimate partner violence. Methods: qualitative research anchored in Sanicola's social network framework. A total of 21 women attended at a specialized social assistance service in Porto Velho-Rondônia, Brazil, participated in a semi-structured interview. Results: the analysis of network maps showed that the secondary social support network mobilized had a central character in the lives of women in situations of violence. These women sought the third sector's secondary network, the churches, from which they received emotional-affective and spiritual support. Final Considerations: understanding the social network setting and the type of support offered can contribute to improving care for women and strengthening interpersonal and institutional ties that help in the search for breaking the situation of violence.

RESUMEN Objetivos: analizar las posibilidades de apoyo que ofrece la red de apoyo social a las mujeres en situación de violencia de pareja. Métodos: investigación cualitativa, anclada en el marco de la red social de Sanicola. Participaron 21 mujeres atendidas en un servicio de asistencia social especializado en Porto Velho-Rondônia, Brasil, que respondieron a una entrevista semiestructurada. Resultados: el análisis de los mapas de redes mostró que la red de apoyo social secundaria movilizada tuvo un carácter central en la vida de las mujeres en situación de violencia. Estas mujeres buscaron la red secundaria del tercer sector, las iglesias, de donde recibieron apoyo emocional-afectivo y espiritual. Consideraciones Finales: comprender la configuración de la red social y el tipo de apoyo ofrecido puede contribuir para la mejora de la atención a la mujer y el fortalecimiento de lazos interpersonales e institucionales que ayuden en la búsqueda de ruptura de la situación de violencia.

RESUMO Objetivos: analisar as possibilidades de suporte que a rede de apoio social oferece às mulheres em situação de violência por parceiro íntimo. Métodos: pesquisa qualitativa, ancorada no referencial de rede social de Sanicola. Participaram 21 mulheres atendidas em um serviço especializado de assistência social de Porto Velho-Rondônia, Brasil, que responderam à entrevista semiestruturada. Resultados: a análise dos mapas de redes mostrou que a rede de apoio social secundária mobilizada teve um caráter central na vida da mulher em situação de violência. Essas mulheres buscaram a rede secundária de terceiro setor, as igrejas, das quais receberam suporte emocional-afetivo e espiritual. Considerações Finais: a compreensão da configuração da rede social e do tipo de apoio ofertado pode contribuir para a melhoria do cuidado à mulher e fortalecimento dos laços interpessoais e institucionais que auxiliam na busca do rompimento da situação de violência.

Satisfação e insatisfação no parto normal sob o enfoque dos atributos da qualidade da assistência / Satisfaction and dissatisfaction with normal birth from the care quality attributes standpoint / Satisfacción e insatisfacción en el parto normal bajo el enfoque de los atributos de la calidad de la asistencia

Objetivo: analisar os atributos da assistência ao parto normal relacionados com a satisfação e insatisfação na perspectiva de puérperas. Método: estudo qualitativo, com 30 puérperas, em maternidade do município do Rio de Janeiro, Brasil, realizada de outubro de 2019 a janeiro de 2020. As entrevistas foram submetidas à análise de conteúdo temática e referencial da estrutura da qualidade. Pesquisa aprovada por Comitê de Ética em Pesquisa. Resultados: a satisfação na assistência ao parto foi relacionada à comunicação eficaz, respeito à privacidade e autonomia com suporte emocional, convergentes com a estrutura da qualidade. A insatisfação foi atribuída à postura profissional desrespeitosa, à deficiência na infraestrutura e aos recursos no serviço. Considerações finais: escuta qualificada, assistência respeitosa e centrada na mulher foram basilares na qualidade percebida pelas participantes. Entretanto, a insatisfação foi relacionada à persistência de fragilidades na rede de atenção ao parto normal.

Objective: to examine the attributes of birth care associated with childbearing women's satisfaction and dissatisfaction. Method: this qualitative study was conducted from October 2019 to January 2020 with 30 puerperal women at a maternity unit in the municipality of Rio de Janeiro, Brazil. The interviews were subjected to thematic content analysis and the quality structure frame of reference. The study was approved by the research ethics committee. Results: satisfaction with birth care was related to effective communication, respect for privacy, and autonomy with emotional support, which are convergent with a quality framework. Dissatisfaction was attributed to disrespectful professional behaviour, deficient infrastructure, and deficient service resources. Final Considerations: qualified listening, respectful and woman-centred care were crucial to participants' perceptions of quality. Dissatisfaction, meanwhile, was related to persistent shortcomings in the normal birth care system.

Objetivo: analizar los atributos de asistencia al parto relacionados con la satisfacción y la insatisfacción en la perspectiva de puérperas. Método: estudio cualitativo junto a 30 puérperas en una maternidad de Rio de Janeiro, Brasil, realizado de octubre de 2019 a enero de 2020. Se analizaron las entrevistas por contenido temático y referencial de la estructura de calidad. El Comité de Ética en Investigación aprobó la investigación. Resultados: la satisfacción en la asistencia al parto estuvo relacionada con la comunicación eficaz, respecto a la privacidad y autonomía con apoyo emocional, convergentes con la estructura de la calidad. La insatisfacción se atribuyó a la postura profesional irrespetuosa, la deficiencia de infraestructura y a los recursos del servicio. Consideraciones finales: escucha cualificada, asistencia respetuosa y centrada en la mujer fueron fundamentales en la calidad que las participantes mencionaron. Sin embargo, la insatisfacción estuvo relacionada con la persistencia de fragilidades en la red de atención al parto normal.

Satisfação e insatisfação no parto normal sob o enfoque dos atributos da qualidade da assistência / Satisfacción e insatisfacción en el parto normal bajo el enfoque de los atributos de la calidad de la asistencia / Satisfaction and dissatisfaction with normal birth from the care quality attributes standpoint

RESUMO Objetivo analisar os atributos da assistência ao parto normal relacionados com a satisfação e insatisfação na perspectiva de puérperas. Método estudo qualitativo, com 30 puérperas, em maternidade do município do Rio de Janeiro, Brasil, realizada de outubro de 2019 a janeiro de 2020. As entrevistas foram submetidas à análise de conteúdo temática e referencial da estrutura da qualidade. Pesquisa aprovada por Comitê de Ética em Pesquisa. Resultados a satisfação na assistência ao parto foi relacionada à comunicação eficaz, respeito à privacidade e autonomia com suporte emocional, convergentes com a estrutura da qualidade. A insatisfação foi atribuída à postura profissional desrespeitosa, à deficiência na infraestrutura e aos recursos no serviço. Considerações finais escuta qualificada, assistência respeitosa e centrada na mulher foram basilares na qualidade percebida pelas participantes. Entretanto, a insatisfação foi relacionada à persistência de fragilidades na rede de atenção ao parto normal.

RESUMEN Objetivo analizar los atributos de asistencia al parto relacionados con la satisfacción y la insatisfacción en la perspectiva de puérperas. Método estudio cualitativo junto a 30 puérperas en una maternidad de Rio de Janeiro, Brasil, realizado de octubre de 2019 a enero de 2020. Se analizaron las entrevistas por contenido temático y referencial de la estructura de calidad. El Comité de Ética en Investigación aprobó la investigación. Resultados la satisfacción en la asistencia al parto estuvo relacionada con la comunicación eficaz, respecto a la privacidad y autonomía con apoyo emocional, convergentes con la estructura de la calidad. La insatisfacción se atribuyó a la postura profesional irrespetuosa, la deficiencia de infraestructura y a los recursos del servicio. Consideraciones finales escucha cualificada, asistencia respetuosa y centrada en la mujer fueron fundamentales en la calidad que las participantes mencionaron. Sin embargo, la insatisfacción estuvo relacionada con la persistencia de fragilidades en la red de atención al parto normal.

ABSTRACT Objective to examine the attributes of birth care associated with childbearing women's satisfaction and dissatisfaction. Method this qualitative study was conducted from October 2019 to January 2020 with 30 puerperal women at a maternity unit in the municipality of Rio de Janeiro, Brazil. The interviews were subjected to thematic content analysis and the quality structure frame of reference. The study was approved by the research ethics committee. Results satisfaction with birth care was related to effective communication, respect for privacy, and autonomy with emotional support, which are convergent with a quality framework. Dissatisfaction was attributed to disrespectful professional behaviour, deficient infrastructure, and deficient service resources. Final Considerations qualified listening, respectful and woman-centred care were crucial to participants' perceptions of quality. Dissatisfaction, meanwhile, was related to persistent shortcomings in the normal birth care system.

Clinical Outcome of Patients Submitted to Liver Resection in the Context of Metastatic Breast Cancer: A Study of a Tertiary Hospital Center.

INTRODUCTION: Breast cancer is the most incident cancer in the world, accounting for 25% of new cancers per year in females. It is the most frequent malignancy in women, being the fifth cause of death from cancer worldwide. Approximately 5 to 10% of patients already present with metastases at diagnosis, and the liver is the site of metastases in half of these cases. Liver metastasis (LM) resection, performed after neoadjuvant systemic treatment, has been reported to increase median overall survival in this population. AIM: The aim of this analysis is to assess the outcomes of patients undergoing breast cancer liver metastasis surgical resection, including impact on survival, compared to patients where metastasectomy was not performed. METHODS: retrospective review of 55 female patients with breast cancer liver metastases, diagnosed and treated in a single tertiary university hospital from January 2011 to December 2016 was performed. RESULTS: In 32/55 patients (58.2%), multi-organ metastases were identified (the most common sites being bone, lungs, and lymph nodes). Of the remaining 23 patients, the liver was the unique metastatic site; thirteen patients had diffuse bilobar hepatic metastases. The remaining ten patients were proposed for surgical treatment; three of them had peritoneal carcinomatosis identified during surgery, and no hepatic metastasectomy was performed. As a result, only seven (12.7%) patients underwent liver metastasectomy. Overall survival was higher in patients who had LM surgery (65 months [Interquartile Range (IQR) 54-120]), in comparison to those diagnosed with diffuse bilobar hepatic metastases (17.5 months [IQR 11-41]), and with those showing concurrent liver and bone metastases (16.5 months [IQR 6-36]) (p = 0.012). In univariable analysis, the latter two groups showed worse overall survival outcomes (Hazard Ratio (HR) = 3.447, 95%CI: 1.218-9.756, p = 0.02 and HR = 3.855, 95% Confidence Interval (CI): 1.475-10.077, p = 0.006, respectively) when compared to patients with LM. CONCLUSION: In our series, patients submitted to metastasectomy had a median overall survival after diagnosis of LM three times greater than the non-operated patients with isolated LM, or concurrent LM and bone metastases (65 vs. 17.5 and 16.5 months, respectively). As is vastly known for colorectal cancer liver metastasis, resection of breast cancer liver metastasis may reduce tumor burden, and therefore may improve patient outcome.