Pathological, morphological, and molecular characterization of the infection by Brachycladium goliath in humpback whale Megaptera novaeangliae.

The humpback whale (Megaptera novaeangliae) is a cosmopolitan migratory, seasonal mysticete that frequents the Brazilian coast. Strands of specimens may occur during the migratory stay in the country. In 2021 and 2022, three live humpback whales stranded on the coast of Rio Grande do Sul and Santa Catarina states in southern Brazil. After euthanasia, specimens were necropsied, and organs were thoroughly examined for lesions. Grossly, in all three cases, the liver exhibited multifocal, irregular, firm, white areas on the hepatic capsule, which extended into the parenchyma. On the cut surface, the livers were yellow to pale brown with orangish to greenish areas, the bile ducts were prominent, thickened, and severely dilated, and leaf-shaped flukes were found inside of them. Additionally, one case showed moderate atrophy of the right hepatic lobe. The histological findings included dilation of bile ducts, hyperplasia of the bile duct epithelium, marked inflammatory infiltration of lymphocytes, plasma cells, and eosinophils, and portal fibrosis. The parasite Brachycladium goliath was both morphologically and molecularly identified based on diagnostic key for trematodes and the original description of the species, and the amplification and sequencing of the ITS-2 region, respectively. Even though hepatic injury was not the primary cause of stranding, it may have contributed to the debilitation of the whales. To the authors' knowledge, this is the first study that reports M. novaeangliae as a definitive host of B. goliath and that describes the lesions caused by the parasite in cetaceans.

[Evaluation of the behavioral program in type 2 diabetes mellitus: a randomized clinical trial]. / Avaliação do programa comportamental em diabetes mellitus tipo 2: ensaio clínico randomizado.

The scope of this article was to evaluate the effect of the behavioral group education program and telephone intervention in modifying psychological attitudes, enhancing empowerment, and self-care practices aimed at improving clinical control in type 2 diabetes mellitus. It involved a randomized cluster clinical trial, carried out with 199 people with diabetes. In order to perform intragroup comparisons (final and initial phases) and between groups with respect to the indices of the psychological attitude, empowerment, self-care and glycated hemoglobin level variables, the Generalizing Estimating Equation (GEE) approach was used. In all analyses, a 5% significance level and 95% confidence interval were used. When compared to the CG, the IG showed a significant reduction in the mean values of glycated hemoglobin (95%CI: -1.49 to -0.45), a statistically significant increase in the change in psychological attitude scores (95%CI: 9.70 to 15.40), on the empowerment scale (95%CI: 0.81 to 2.72) and adherence to self-care practices (95%CI: 1.44 to 2.10) at the end of the study. The behavioral program proved to be capable of modifying psychological attitudes, improving empowerment, self-care practices and clinical control.

O objetivo deste artigo é avaliar o efeito do programa comportamental educação em grupo e intervenção telefônica na modificação das atitudes psicológicas, melhora do empoderamento e das práticas de autocuidado visando à melhora do controle clínico em diabetes mellitus tipo 2. Trata-se de um ensaio clínico com cluster randomizado, realizado em 199 pessoas com diabetes. Para realizar as comparações intragrupos (tempos final e inicial) e entre grupos quanto aos valores das variáveis atitudes psicológicas, empoderamento, autocuidado e medidas da hemoglobina glicada, foi utilizada a abordagem das Generalizing Estimating Equations (GEE). Em todas as análises, utilizou-se um nível de significância de 5% e intervalos de 95% de confiança. Quando comparado ao GC, o GI apresentou uma redução significativa nos valores médios de hemoglobina glicada (IC95%: -1,49 a - 0,45), aumento estatisticamente significativo na modificação dos escores de atitudes psicológicas (IC95%: 9,70 a 15,40), na escala do empoderamento (IC95%: 0,81 a 2,72) e na adesão às práticas de autocuidado (IC95%: 1,44 a 2,10) ao final do estudo. O programa comportamental se mostrou capaz de modificar as atitudes psicológicas, melhorar o empoderamento, as práticas de autocuidado e o controle clínico.

Avaliação do programa comportamental em diabetes mellitus tipo 2: ensaio clínico randomizado / Evaluation of the behavioral program in type 2 diabetes mellitus: a randomized clinical trial

Resumo O objetivo deste artigo é avaliar o efeito do programa comportamental educação em grupo e intervenção telefônica na modificação das atitudes psicológicas, melhora do empoderamento e das práticas de autocuidado visando à melhora do controle clínico em diabetes mellitus tipo 2. Trata-se de um ensaio clínico com cluster randomizado, realizado em 199 pessoas com diabetes. Para realizar as comparações intragrupos (tempos final e inicial) e entre grupos quanto aos valores das variáveis atitudes psicológicas, empoderamento, autocuidado e medidas da hemoglobina glicada, foi utilizada a abordagem das Generalizing Estimating Equations (GEE). Em todas as análises, utilizou-se um nível de significância de 5% e intervalos de 95% de confiança. Quando comparado ao GC, o GI apresentou uma redução significativa nos valores médios de hemoglobina glicada (IC95%: -1,49 a - 0,45), aumento estatisticamente significativo na modificação dos escores de atitudes psicológicas (IC95%: 9,70 a 15,40), na escala do empoderamento (IC95%: 0,81 a 2,72) e na adesão às práticas de autocuidado (IC95%: 1,44 a 2,10) ao final do estudo. O programa comportamental se mostrou capaz de modificar as atitudes psicológicas, melhorar o empoderamento, as práticas de autocuidado e o controle clínico.

Abstract The scope of this article was to evaluate the effect of the behavioral group education program and telephone intervention in modifying psychological attitudes, enhancing empowerment, and self-care practices aimed at improving clinical control in type 2 diabetes mellitus. It involved a randomized cluster clinical trial, carried out with 199 people with diabetes. In order to perform intragroup comparisons (final and initial phases) and between groups with respect to the indices of the psychological attitude, empowerment, self-care and glycated hemoglobin level variables, the Generalizing Estimating Equation (GEE) approach was used. In all analyses, a 5% significance level and 95% confidence interval were used. When compared to the CG, the IG showed a significant reduction in the mean values of glycated hemoglobin (95%CI: -1.49 to -0.45), a statistically significant increase in the change in psychological attitude scores (95%CI: 9.70 to 15.40), on the empowerment scale (95%CI: 0.81 to 2.72) and adherence to self-care practices (95%CI: 1.44 to 2.10) at the end of the study. The behavioral program proved to be capable of modifying psychological attitudes, improving empowerment, self-care practices and clinical control.

Daily activity timing in the Anthropocene.

Animals are facing novel 'timescapes' in which the stimuli entraining their daily activity patterns no longer match historical conditions due to anthropogenic disturbance. However, the ecological effects (e.g., altered physiology, species interactions) of novel activity timing are virtually unknown. We reviewed 1328 studies and found relatively few focusing on anthropogenic effects on activity timing. We suggest three hypotheses to stimulate future research: (i) activity-timing mismatches determine ecological effects, (ii) duration and timing of timescape modification influence effects, and (iii) consequences of altered activity timing vary biogeographically due to broad-scale variation in factors compressing timescapes. The continued growth of sampling technologies promises to facilitate the study of the consequences of altered activity timing, with emerging applications for biodiversity conservation.

The Aryl Hydrocarbon Receptor Ligand FICZ Improves Left Ventricular Remodeling and Cardiac Function at the Onset of Pressure Overload-Induced Heart Failure in Mice.

Adverse ventricular remodeling is the heart's response to damaging stimuli and is linked to heart failure and poor prognosis. Formyl-indolo [3,2-b] carbazole (FICZ) is an endogenous ligand for the aryl hydrocarbon receptor (AhR), through which it exerts pleiotropic effects including protection against inflammation, fibrosis, and oxidative stress. We evaluated the effect of AhR activation by FICZ on the adverse ventricular remodeling that occurs in the early phase of pressure overload in the murine heart induced by transverse aortic constriction (TAC). Cardiac structure and function were evaluated by cardiac magnetic resonance imaging (CMRI) before and 3 days after Sham or TAC surgery in mice treated with FICZ or with vehicle, and cardiac tissue was used for biochemical studies. CMRI analysis revealed that FICZ improved cardiac function and attenuated cardiac hypertrophy. These beneficial effects involved the inhibition of the hypertrophic calcineurin/NFAT pathway, transcriptional reduction in pro-fibrotic genes, and antioxidant effects mediated by the NRF2/NQO1 pathway. Overall, our findings provide new insight into the role of cardiac AhR signaling in the injured heart.

Is Campus a Place of (In)Security and Crime? Perceptions and Predictors among Higher Education Students.

This paper addresses subjective insecurity, namely perceptions of (in)security and criminal variables on campus among Portuguese higher education students. Additionally, predictors of perceptions of (in)security and gender differences were also examined. The participants were 775 students and data were collected through the "Diagnosis of Local Security Questionnaire". Robbery, physical assault, theft, and sexual offenses were the most feared crimes. Additionally, robbery, theft, and public property damage were perceived as the most common on campus. Alcohol/drug consumption and juvenile conflicts/delinquency were the main reasons justifying criminal occurrences. Sociodemographic variables such as gender, age, education, and years of campus attendance, as well as criminal variables (e.g., perceived trend of crime, criminal occurrences, and crime promoters) predicted perceptions of (in)security. Females reported more fear than males of robbery, sexual offenses, physical aggression, and domestic violence. Therefore, preventive measures, including in the social domain and physical spaces, are mandatory to reduce violence on campus.

The anti-aging factor Klotho protects against acquired long QT syndrome induced by uremia and promoted by fibroblast growth factor 23.

BACKGROUND: Chronic kidney disease (CKD) is associated with increased propensity for arrhythmias. In this context, ventricular repolarization alterations have been shown to predispose to fatal arrhythmias and sudden cardiac death. Between mineral bone disturbances in CKD patients, increased fibroblast growth factor (FGF) 23 and decreased Klotho are emerging as important effectors of cardiovascular disease. However, the relationship between imbalanced FGF23-Klotho axis and the development of cardiac arrhythmias in CKD remains unknown. METHODS: We carried out a translational approach to study the relationship between the FGF23-Klotho signaling axis and acquired long QT syndrome in CKD-associated uremia. FGF23 levels and cardiac repolarization dynamics were analyzed in patients with dialysis-dependent CKD and in uremic mouse models of 5/6 nephrectomy (Nfx) and Klotho deficiency (hypomorphism), which show very high systemic FGF23 levels. RESULTS: Patients in the top quartile of FGF23 levels had a higher occurrence of very long QT intervals (> 490 ms) than peers in the lowest quartile. Experimentally, FGF23 induced QT prolongation in healthy mice. Similarly, alterations in cardiac repolarization and QT prolongation were observed in Nfx mice and in Klotho hypomorphic mice. QT prolongation in Nfx mice was explained by a significant decrease in the fast transient outward potassium (K+) current (Itof), caused by the downregulation of K+ channel 4.2 subunit (Kv4.2) expression. Kv4.2 expression was also significantly reduced in ventricular cardiomyocytes exposed to FGF23. Enhancing Klotho availability prevented both long QT prolongation and reduced Itof current. Likewise, administration of recombinant Klotho blocked the downregulation of Kv4.2 expression in Nfx mice and in FGF23-exposed cardiomyocytes. CONCLUSION: The FGF23-Klotho axis emerges as a new therapeutic target to prevent acquired long QT syndrome in uremia by minimizing the predisposition to potentially fatal ventricular arrhythmias and sudden cardiac death in patients with CKD.

Evidence for ecological processes driving speciation among endemic lizards of Madagascar.

Although genetic patterns produced by population isolation during speciation are well documented, the biogeographic and ecological processes that trigger speciation remain poorly understood. Alternative hypotheses for the biogeography and ecology of speciation include geographic isolation combined with niche conservation (soft allopatry) or parapatric distribution on an environmental gradient with niche divergence (ecological speciation). Here, we use species' distributions, environmental data, and two null models (the Random Translation and Rotation and the Background Similarity Test) to test these alternative hypotheses among 28 sister pairs of microendemic lizards in Madagascar. Our results demonstrate strong bimodal peaks along a niche divergence-conservation spectrum, with at least 25 out of 28 sister pairs exhibiting either niche conservation or divergence, and the remaining pairs showing weak ecological signals. Yet despite these significant results, we do not find strong associations of niche conservation with allopatric distributions or niche divergence with parapatric distributions. Our findings thus provide strong evidence of a role for ecological processes driving speciation, rather than the classic expectation of speciation through geographic isolation, but demonstrate that the link between ecological speciation and parapatry is complex and requires further analysis of a broader taxonomic sample to fully resolve.

Looking at crime-communities and physical spaces: A curated dataset.

This article describes a curated dataset entitled "Looking at Crime: Communities and Physical Spaces", which comprises data from different sources, namely Diagnosis of Local Security (DLS), Diagnosis of School Environment (DSE) and observation of physical spaces. The main topic covered was crime and related variables at the Historic Centre of Porto (HCP), a well-known urban area located in the North of Portugal. It is currently attended by inhabitants, workers, students and tourists. This dataset includes i) data from two different self-reports: i.1) demographics, perception of (in)security, victimization, social control and community cohesion obtained through an inquiry applied to the adult community; and i.2) data from school climate and students behavioural problems, which may be seen as risk factors for juvenile delinquency, collected through a web-survey applied to school personnel; and ii) data from observation of physical spaces, attending to the Crime Prevention through Environmental Design (CPTED) principles. The dataset allows descriptive and inferential statistical analyses, being useful for students, academics, stakeholders, police forces and policy-makers, to better understand crime and its related variables, forecast criminal incidents, and further develop associated preventive and intervention programmes.

Identifying mismatches between conservation area networks and vulnerable populations using spatial randomization.

Grassland birds are among the most globally threatened bird groups due to substantial degradation of native grassland habitats. However, the current network of grassland conservation areas may not be adequate for halting population declines and biodiversity loss. Here, we evaluate a network of grassland conservation areas within Wisconsin, U.S.A., that includes both large Focal Landscapes and smaller targeted conservation areas (e.g., Grassland Bird Conservation Areas, GBCAs) established within them. To date, this conservation network has lacked baseline information to assess whether the current placement of these conservation areas aligns with population hot spots of grassland-dependent taxa. To do so, we fitted data from thousands of avian point-count surveys collected by citizen scientists as part of Wisconsin's Breeding Bird Atlas II with multinomial N-mixture models to estimate habitat-abundance relationships, develop spatially explicit predictions of abundance, and establish ecological baselines within priority conservation areas for a suite of obligate grassland songbirds. Next, we developed spatial randomization tests to evaluate the placement of this conservation network relative to randomly placed conservation networks. Overall, less than 20% of species statewide populations were found within the current grassland conservation network. Spatial tests demonstrated a high representation of this bird assemblage within the entire conservation network, but with a bias toward birds associated with moderately tallgrasses relative to those associated with shortgrasses or tallgrasses. We also found that GBCAs had higher representation at Focal Landscape rather than statewide scales. Here, we demonstrated how combining citizen science data with hierarchical modeling is a powerful tool for estimating ecological baselines and conducting large-scale evaluations of an existing conservation network for multiple grassland birds. Our flexible spatial randomization approach offers the potential to be applied to other protected area networks and serves as a complementary tool for conservation planning efforts globally.

Herbs and herbal infusions: Determination of natural contaminants (mycotoxins and trace elements) and evaluation of their exposure.

Herbal infusions are amongst the world's most popular and widely enjoyed beverages, due to both large variety and convenience. However, natural contaminants, such as mycotoxins and trace elements can accumulate in aromatic herbs, which may have serious food safety and public health implications. In this study, the presence of mycotoxins, as well as the content of trace elements was evaluated in herbs and herbal infusions commercialized in Brazil. For the determination of fourteen mycotoxins, including the emerging mycotoxins enniatins (EN), beauvericin (BEA), and sterigmatocystin (STE), a liquid-chromatography tandem mass spectrometry (LC-MS/MS) method was validated. Overall, 42 out of 58 herb samples (72%) were contaminated, being BEA the most usual mycotoxin, present in 43% of the samples, followed by STE and HT-2 toxin, present in 37% and 24% of the samples, respectively. In herbal infusions, the occurrence of mycotoxins was 88% lesser than those verified in raw products. Despite these low levels, the hazard quotient (HQ) calculated revealed a potential health concern for HT-2 in infusions. The margin of exposure values for aflatoxins (AF), and ochratoxin A (OTA) from six herbal infusions were below 10,000, indicating also potential health risks. The twenty-one trace elements comprising toxic elements such as arsenic (As), cadmium (Cd), and lead (Pb) were determined in herb raw materials by inductively coupled plasma-mass spectrometry (ICP-MS). The levels of trace elements in herbs were very varied, with aluminum (Al) presenting the highest amount. The levels of legislated elements (As, Cd, Pb) analyzed in herbs were lower than 3.03 µg g-1 (Pb), thus not exceeding the legal limits defined for herbal medicinal by both European and Brazilian pharmacopeia.

Assessment of the complexity of drug therapy and psychosocial and behavioral aspects in people living with type 2 diabetes mellitus.

Background Type 2 diabetes mellitus is a public health problem worldwide. The complexity of drug therapy and behavioral aspects are important factors in its management. Objective To characterize the complexity of drug therapy, attitudes, empowerment and self-care in people with type 2 diabetes mellitus. Methods Observational descriptive study involving people with type 2 diabetes mellitus recruited in eight public primary care settings in Brazil, 2018. We used validated instruments to determine the complexity of drug therapy employing the Medication Regimen Complexity Index, and to describe the behavioral aspects, encompassing Diabetes Attitudes Questionnaires, Diabetes Empowerment Scale-Short Form and Diabetes Mellitus Care Self-Management. Results The 119 participants showed median age of 64 years (Quartile 1 57.0; Quartile 3 71.0) with predominance of women (68.1%). We found high percentages of participants with low scores on attitudes (87.9%) and self-care (84.8%) questionnaires, but with high scores on empowerment questionnaire (81.8%) in groups with high complexity of drug therapy. Conclusion High complexity of drug therapy concentrated low scores for attitudes and self-care, even though presenting elevated empowerment scores. Further studies are needed to investigate the effect of these aspects on the behavior of people with type 2 diabetes mellitus on drug therapies of high complexity.

Avaliação do programa comportamental - educação em grupo e intervenção telefônica (PCEGIT) em diabetes tipo 2: ensaio clínico randomizado / Behavioral program evaluation - group education and telephone intervention (PCEGIT) in type 2 diabetes: randomized clinical trial

Introdução: O Diabetes mellitus tipo 2 (DM2) é uma condição crônica de causa multifatorial, associado, principalmente, a maus comportamentos, como alimentação inadequada e sedentarismo. Frente a este cenário, o programa comportamental composto por estratégias metodológicas, como a educação em grupo e intervenção telefônica (PCEGIT), pautadas na comunicação e na construção de alicerces para o autocuidado, configura­se uma alternativa viável. Objetivo: Avaliar o efeito do programa comportamental educação em grupo e intervenção telefônica (PCEGIT) na modificação das atitudes psicológicas, melhora do empoderamento e das práticas de autocuidado visando à melhora do controle clínico em diabetes mellitus tipo 2. Método: Trata­se de um ensaio clínico randomizado por cluster, com acompanhamento de doze meses, realizado com 199 pessoas com diabetes mellitus tipo 2, provenientes de seis Unidades Básicas de Saúde, que foram alocadas em dois grupos: três unidades como grupo controle (n=91), que receberam o atendimento convencional, e três como grupo intervenção (n=108), que receberam as estratégias metodológicas comportamentais. Compôs­se o estudo em seis etapas de seguimento. Antes do tempo inicial (Ti), realizou­se a fase exploratória com análise descritiva dos dados de todas as pessoas com diabetes tipo 2 das Unidades Básicas de Saúde da regional Leste de Belo Horizonte ­ Minas Gerais (MG). Em tempo inicial (Ti), realizou­se a coleta das variáveis clínicas, sociodemográficas, antropométricas, atitudes psicológicas, autocuidado e empoderamento para os grupos controle e intervenção. Em tempo zero (T0), três meses (T3) e seis meses (T6), realizaram­se as estratégias metodológicas comportamentais, como a educação em grupo e a intervenção telefônica, com intervalo de três meses entre os tempos e o monitoramento telefônico uma vez por mês, nos intervalos. Em tempo final (Tf), três meses após tempo seis meses (T6), realizouse novamente a coleta das variáveis clínicas, sociodemográficas, antropométricas, atitudes, autocuidado e empoderamento. Em tempo doze meses (T12), um mês após o tempo final (Tf), realizou­se o encerramento das estratégias para os grupos controle e intervenção, e a análise descritiva, por meio do cálculo de frequências para as variáveis categóricas e medidas de tendência central (média e mediana) e de dispersão (desvio­padrão ­ DP) para as variáveis quantitativas. Aplicou­se o teste de Shapiro­Wilk para verificar a suposição de distribuição normal para as variáveis hemoglobina glicada (Hb1Ac), atitudes (ATT­19), empoderamento (DES) e nível de autocuidado (ESM) (p < 0,05). Para as mesmas variáveis, utilizou­se o teste dos sinais para testar diferenças consistentes entre pares de observações antes e depois da intervenção. Definiu­se o efeito do experimento como a diferença entre seus valores, no período final e período inicial (Δ), dividido pelo valor inicial. Por fim, para avaliar os efeitos do programa comportamental, utilizaram­se os testes t de Student pareado e Wilcoxon para comparação da média e mediana. Em todas as análises, utilizou­se um nível de significância de 5%. Resultados: A média de idade do grupo estudado foi de 63 anos; a maioria foi do sexo feminino, 68,3%; 68,3% eram casados; em relação à escolaridade, 42,7% estudaram até o ensino fundamental; 52,8% declaram­se pardos ou amarelos; 39,8 % eram aposentados e 69,6% possuíam renda familiar mensal entre 1 a 2 salários mínimos. Com relação aos parâmetros clínicos, observou­se que, entre as pessoas do GI, houve uma redução estatisticamente significativa nos valores medianos de HbA1c (p<0,05) no tempo final. Entre os indivíduos do GC, após o término do estudo, houve aumento significativo nos valores medianos de HbA1c (p<0,05). Ademais, considerou­se, estatisticamente, a diferença entre as medianas de ΔHbA1c dos dois grupos significantes (p = 0.000). No que tange à modificação das atitudes (ATT­19), perceberam­se evidências significativas de diminuição da pontuação ao final do estudo no GC(p<0,05), enquanto, no GI, houve diferença estatisticamente significativa, com indicativo de aumento nos escores ao final do estudo (p<0,05). Quanto à escala do empoderamento (DES), houve estabilidade do escore mediano após a intervenção tanto no GI quanto no GC (p>0,05). No entanto, comparando­se os efeitos medianos do GI e do GC, consideram­se os dois grupos estatisticamente diferentes (p<0,05). Quanto à adesão às práticas de autocuidado (ESM), obtiveram­se resultados estatisticamente significativos na comparação dos períodos pré e pósintervenção no GI, evidenciando um aumento do escore mediano nesse grupo (p<0,05). O mesmo resultado não pode ser observado no GC (p>0,05). Considerou­se a diferença entre os dois grupos, quanto ao efeito do experimento, nos escores do ESM, significante (p = 0.000). Além disso, ao se compararem os efeitos medianos dos GC com GI para as varáveis clínicas, no tempo final, verificou­se que VLDL, LDL e TGL foram estatisticamente diferentes (p<0,05). Conclusão: O programa comportamental educação em grupo e intervenção telefônica (PCEGIT) se mostrou capaz de modificar as atitudes psicológicas, manteve os níveis de empoderamento e favoreceu as práticas de autocuidado, principalmente para uma alimentação saudável e prática de exercício físico, além de melhora dos níveis glicêmicos, evidenciada pelos resultados da hemoglobina glicada.

O uso do aplicativo móvel whatsapp na saúde: revisão integrativa / El uso de la aplicación móvil whatsapp en salud: revisión integrativa / The use of the whatsapp mobile application in health: integrative review

RESUMO Objetivo: identificar o estado atual da arte e as tendências de pesquisas que utilizam o aplicativo móvel WhatsApp na área da saúde. Método: revisão integrativa da literatura nas bases de dados PubMed, CINAHL, SCOPUS e LILACS, no período de 2009 a 2019. Resultados: amostra composta de 24 estudos agrupados em três categorias de análise: uso do WhatsApp por profissionais/estudantes da área da saúde como ferramenta de comunicação, ensino e aprendizagem (n=5); uso do WhatsApp pelo profissional no serviço de saúde (n=13); e uso do WhatsApp para educação em saúde/ troca de informação entre profissional e paciente (n=6). Conclusão: evidências científicas mostram que o uso do WhatsApp favorece a comunicação existente entre os profissionais em um serviço de saúde e até mesmo entre profissionais, estudantes da área da saúde e pacientes.

RESUMEN Objetivo: identificar el estado actual del arte y las tendencias de investigación que utilizan la aplicación móvil WhatsApp en la atención médica. Método: revisión integrativa de la literatura en las bases de datos PubMed, CINAHL, SCOPUS y LILACS, en el período de 2009 a 2019. Resultados: muestra compuesta por 24 estudios agrupados en tres categorías de análisis: uso do WhatsApp por profesionales/estudiantes de salud como herramienta de comunicación, enseñanza y aprendizaje (n=5); uso de WhatsApp por parte del profesional del servicio de salud (n=13); y uso de WhatsApp para educación en salud/intercambio de información entre profesional y paciente (n=6). Conclusión: la evidencia científica muestra que el uso de WhatsApp favorece la comunicación existente entre los profesionales de un servicio de salud e incluso entre profesionales, estudiantes de salud y pacientes.

ABSTRACT Objective: to identify the current state of the art and research trends that use the mobile WhatsApp application in the healthcare. Method: integrative literature review in the databases PubMed, CINAHL, SCOPUS and LILACS, from 2009 to 2019. Results: sample composed of 24 studies grouped into three analysis categories: use of WhatsApp by healthcare professionals/students as a communication, teaching and learning tool (n=5); use of WhatsApp by the professional in the health service (n=13); and use of WhatsApp for health education/information exchange between professional and patient (n=6). Conclusion: scientific evidence shows that the use of WhatsApp favors the existing communication between professionals in a healthcare service and even between professionals, healthcare students and patients.

Atitudes para o autocuidado em diabetes mellitus tipo 2 na Atenção Primária / Actitudes de autocuidado en diabetes mellitus tipo 2 en la Atención Primaria / Attitudes towards self-care in type 2 diabetes mellitus in primary care

Resumo Objetivo Analisar as atitudes para o autocuidado de pessoas com diabetes tipo 2 na Atenção Primária. Métodos Estudo descritivo-exploratório, realizado com 18 pessoas com diabetes tipo 2 vinculadas a duas Unidades Básicas de Saúde, que participaram de entrevistas e grupos focais. Os conteúdos textuais foram processados no software IRaMuTeQ. Para avaliar a associação entre as variáveis categóricas, foi utilizado o teste qui-quadrado. Para todas as análises, foi considerado um nível de significância de 5%. Resultados Os achados apresentaram uma classe semântica associada às atitudes para o autocuidado em diabetes mellitus tipo 2, e as outras quatro subclasses, com ideias complementares, decrescentes e lógicas, referiram-se aos aspectos emocionais, comportamentais, cognitivos e do autocuidado. Observou-se associação entre as subclasses e as variáveis sexo, idade e tempo diagnóstico. Conclusão Devem-se levar em consideração os aspectos emocionais e cognitivos, juntamente das variáveis sexo, idade e tempo diagnóstico, para a modificação das atitudes para o autocuidado em diabetes tipo 2.

Resumen Objetivo Analizar las actitudes de autocuidado de personas con diabetes tipo 2 en la Atención Primaria. Métodos Estudio descriptivo-exploratorio, realizado con 18 personas con diabetes tipo 2 vinculadas a dos Unidades Básicas de Salud, que participaron en entrevistas y grupos focales. Los contenidos textuales fueron procesados en el software IRaMuTeQ. Para evaluar la relación entre las variables categóricas se utilizó la prueba χ2 de Pearson. Se consideró un nivel de significación de 5 % para todos los análisis. Resultados Los resultados presentaron una clase semántica relacionada con las actitudes de autocuidado en diabetes mellitus tipo 2, y las otras cuatro subclases, con ideas complementarias, decrecientes y lógicas, estuvieron asociadas a los aspectos emocionales, de comportamiento, cognitivos y de autocuidado. Se observó una relación entre las subclases y las variables sexo, edad y tiempo de diagnóstico. Conclusión Deben tenerse en cuenta los aspectos emocionales y cognitivos, junto con las variables sexo, edad y tiempo de diagnóstico, para modificar las actitudes de autocuidado en diabetes tipo 2.

Abstract Objective To analyze attitudes towards self-care of people with type 2 diabetes in Primary Care. Methods This is a descriptive-exploratory study, conducted with 18 people with type 2 diabetes linked to two Basic Health Units, who participated in interviews and focus groups. Text content was processed using the IRaMuTeQ software. To assess the association between categorical variables, the chi-square test was used. For all analyses, a significance level of 5% was considered. Results The findings presented a semantic class associated with attitudes towards self-care in type 2 diabetes mellitus, and the other four subclasses, with complementary, decreasing and logical ideas, referred to emotional, behavioral, cognitive and self-care aspects. An association was observed between the subclasses and the variables sex, age and time since diagnosis. Conclusion Emotional and cognitive aspects must be taken into account, together with the variables sex, age and time of diagnosis, for modifying attitudes towards self-care in type 2 diabetes.

Beneficial effects of paricalcitol on cardiac dysfunction and remodelling in a model of established heart failure.

BACKGROUND AND PURPOSE: The synthetic vitamin D3 analogue paricalcitol acts as a selective activator of the vitamin D receptor (VDR). While there is evidence for cardioprotective effects of paricalcitol associated with the VDR pathway, less information is available about the structural and functional cardiac effects of paricalcitol on established heart failure (HF) and particularly its effects on associated electrophysiological or Ca2+ handling remodelling. EXPERIMENTAL APPROACH: We used a murine model of transverse aortic constriction (TAC) to study the effect of paricalcitol on established HF. Treatment was initiated 4 weeks after surgery over five consecutive weeks, and mice were sacrificed 9 weeks after surgery. Cardiac MRI (CMRI) was performed 4 and 9 weeks after surgery. Hearts were used for biochemical and histological studies and to isolate ventricular myocytes for electrophysiological and calcium imaging studies. KEY RESULTS: CMRI analysis revealed that, compared with vehicle, paricalcitol treatment prevented the progression of ventricular dilation and hypertrophy after TAC and halted the corresponding decline in ejection fraction. These beneficial effects were related to the attenuation of intracellular Ca2+ mishandling remodelling, antifibrotic and antihypertrophic effects and potentially antiarrhythmic effects by preventing the reduction of K+ current density and the long QT, JT and TpTe intervals observed in HF animals. CONCLUSION AND IMPLICATIONS: The results suggest that paricalcitol treatment in established HF hampers disease progression and improves adverse electrophysiological and Ca2+ handling remodelling, attenuating the vulnerability to HF-associated ventricular arrhythmias. Paricalcitol may emerge as a potential therapeutic option in the treatment of HF.

Calcitriol, the Bioactive Metabolite of Vitamin D, Increases Ventricular K+ Currents in Isolated Mouse Cardiomyocytes.

Calcitriol, the bioactive metabolite of vitamin D, interacts with the ubiquitously expressed nuclear vitamin D receptor (VDR) to induce genomic effects, but it can also elicit rapid responses via membrane-associated VDR through mechanisms that are poorly understood. The down-regulation of K+ currents is the main origin of electrophysiological remodeling in pathological hypertrophy and heart failure (HF), which can contribute to action potential prolongation and subsequently increase the risk of triggered arrhythmias. Adult mouse ventricular myocytes were isolated and treated with 10 nM calcitriol or vehicle for 15-30 min. In some experiments, cardiomyocytes were pretreated with the Akt inhibitor triciribine. In the adult mouse ventricle, outward K+ currents involved in cardiac repolarization are comprised of three components: the fast transient outward current (Itof), the ultrarapid delayed rectifier K+ current (Ikur), and the non-inactivating steady-state outward current (Iss). K+ currents were investigated using the whole-cell or the perforated patch-clamp technique and normalized to cell capacitance to obtain current densities. Calcitriol treatment of cardiomyocytes induced an increase in the density of Itof and Ikur, which was lost in myocytes isolated from VDR-knockout mice. In addition, calcitriol activated Akt in cardiomyocytes and pretreatment with triciribine prevented the calcitriol-induced increase of outward K+ currents. In conclusion, we demonstrate that calcitriol via VDR and Akt increases both Itof and Ikur densities in mouse ventricular cardiomyocytes. Our findings may provide new mechanistics clues for the cardioprotective role of this hormone in the heart.

Training in diabetes education: meanings attributed by primary care nurses.

OBJECTIVE: seize meanings attributed by primary care nurses to training in diabetes education. METHOD: exploratory and descriptive study, with a qualitative approach, with twenty primary care nurses; semistructured interview script, with interviews processed in the IRaMuTeQ software and analyzed through the Descending Hierarchical Classification. The results were subsidized in the Representational Theory of Meaning. RESULTS: nurse training in diabetes education is insufficient for holistic action, although it allows the community to be instrumentalized in specific issues about the disease, using the limited tools available, especially lectures. Nurses find themselves in a context of challenges, improvisations, weaknesses, and limitations that determine the meaning attributed to diabetes education and subsequent actions. CONCLUSION: the meanings attributed by the nurses revealed an incipient training, which limits the quality of care provided and instigates the search for qualification.

Training in diabetes education: meanings attributed by primary care nurses / Formación en educación en diabetes: significados atribuidos por enfermeros de atención primaria / Formação em educação em diabetes: significados atribuídos por enfermeiros da atenção primária

ABSTRACT Objective: seize meanings attributed by primary care nurses to training in diabetes education. Method: exploratory and descriptive study, with a qualitative approach, with twenty primary care nurses; semistructured interview script, with interviews processed in the IRaMuTeQ software and analyzed through the Descending Hierarchical Classification. The results were subsidized in the Representational Theory of Meaning. Results: nurse training in diabetes education is insufficient for holistic action, although it allows the community to be instrumentalized in specific issues about the disease, using the limited tools available, especially lectures. Nurses find themselves in a context of challenges, improvisations, weaknesses, and limitations that determine the meaning attributed to diabetes education and subsequent actions. Conclusion: the meanings attributed by the nurses revealed an incipient training, which limits the quality of care provided and instigates the search for qualification.

RESUMEN Objetivo: aprehender significados atribuidos por enfermeros de atención primaria a la formación en educación en diabetes. Método: estudio exploratorio y descriptivo, de abordaje cualitativo, con veinte enfermeros de atención primaria; guía semi-estructurado de entrevista con testimonios procesados en el software IRaMuTeQ y analizados por medio de la Clasificación Descendente Jerárquica. Los resultados fueron subsidiados en la Teoría Representacional de Significado. Resultados: la formación del enfermero en la educación en diabetes es insuficiente para la actuación holística, aunque permita instrumentalizar a la comunidad en cuestiones puntuales sobre la enfermedad, utilizando las limitadas herramientas disponibles, sobre todo las conferencias. Los enfermeros se ven en un contexto de desafíos, improvisaciones, fragilidades y limitaciones, determinantes para el significado atribuido a la educación en diabetes y para acciones subsiguientes. Conclusión: los significados atribuidos por los enfermeros revelaron una formación incipiente, lo que limita la calidad de la asistencia prestada e instiga la búsqueda por calificación.

RESUMO Objetivo: apreender significados atribuídos por enfermeiros da atenção primária à formação em educação em diabetes. Método: estudo exploratório e descritivo, de abordagem qualitativa, com vinte enfermeiros da atenção primária; roteiro semiestruturado de entrevista, com depoimentos processados no software IRaMuTeQ e analisados por meio da Classificação Hierárquica Descendente. Os resultados foram subsidiados na Teoria Representacional do Significado. Resultados: a formação do enfermeiro na educação em diabetes é insuficiente para atuação holística, embora permita instrumentalizar a comunidade em questões pontuais acerca da doença, utilizando-se das limitadas ferramentas disponíveis, sobretudo palestras. Os enfermeiros se veem num contexto de desafios, improvisações, fragilidades e limitações, determinantes para o significado atribuído à educação em diabetes e para ações subsequentes. Conclusão: os significados atribuídos pelos enfermeiros revelaram uma formação incipiente, o que limita a qualidade da assistência prestada e instiga a busca pela qualificação.

Adaptação cultural de um instrumento para avaliar as intervenções de educação terapêutica à pessoa com diabetes / Adaptación cultural de un instrumento para evaluar las intervenciones de educación terapéutica a la persona con diabetes / Cross-cultural adaptation of a tool to assess therapeutic educational interventions for diabetes patients

Objetivo: adaptar culturalmente a Escala de Educação Terapêutica para o Comportamento do Autocuidado à Pessoa com Diabetes para o português do Brasil. Método: estudo metodológico, com análise semântica e análise de conteúdo, realizado na cidade de Teresina, Piauí, entre janeiro e julho de 2017. Foi realizada avaliação das equivalências semântica, idiomática, cultural e conceitual por oito enfermeiros. Na análise de conteúdo, foi desenvolvido um brainstorming com participação de 12 especialistas. A avaliação da pertinência prática, relevância e dimensão teórica foi feita por sete profissionais experts. Resultados: as etapas de adaptação cultural foram bem-sucedidas, e as equivalências semântico-idiomáticas, culturais e conceituais foram suficientemente alcançadas. Dos 34 itens do instrumento, 29 sofreram alterações. Obteve-se Índice de Validade de Conteúdo de 0,93 para o conjunto total de itens. Conclusão: evidenciou-se que os itens são pertinentes à cultura brasileira e avaliam aspectos na perspectiva do instrumento original, demonstrando evidências da adaptação cultural.

Objetivo: adaptar culturalmente la Escala de Educación Terapéutica para el Comportamiento del Auto Cuidado a la Persona con Diabetes para el portugués de Brasil. Método: estudio metodológico, con análisis semántico y análisis de contenido, realizado en la ciudad de Teresina, Piauí, entre enero y julio de 2017. Se realizó evaluación de las equivalencias semántica, idiomática, cultural y conceptual por ocho enfermeros. En el análisis de contenido, se desarrolló un brainstorming con participación de 12 especialistas. La evaluación de la pertinencia práctica, relevancia y dimensión teórica se hizo por siete profesionales experts. Resultado: las etapas de adaptación cultural fueron exitosas, y las equivalencias semántico idiomáticas, culturales y conceptuales fueron suficientemente atingidas. De los 34 ítems del instrumento, 29 tuvieron alteraciones. Se obtuvo Índice de Validad de Contenido de 0,93 para el conjunto total de ítems. Conclusión: se evidenció que los ítems son pertinentes a la cultura brasileña y evalúan aspectos en la perspectiva del instrumento original, demostrando evidencias de la adaptación cultural.

ABSTRACT Objective: to identify the use of contraceptive methods by adolescents of a public school in the state of Maranhão. Method: a quantitative, descriptive-exploratory, cross-sectional study was conducted between November and December 2015, with high school adolescents from a public school in the state of Maranhão. Descriptive statistical analysis of the data was performed. Results: of the adolescents, 199 (88.1%) reported having information on contraceptive methods, which was mainly obtained from their mothers, by 139 (69.8%). Of the young women who had information, 184 (92.5%) reported knowing about the male condom. Of the adolescents who had already started sexual activity, some reported not using any method, despite having the information, and 59 (76.6%) young women reported having used the male condom. Conclusion: there is a need to constantly develop health actions in order to allow adolescents to exercise their sexuality more safely, so they avoid sexually transmitted infections and unplanned pregnancies.