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Abstract This paper introduces a novel application of spatial-temporal graph neural networks (ST-GNNs) to predict groundwater levels. Groundwater level prediction is inherently complex, influenced by various hydrological, meteorological, and anthropogenic factors. Traditional prediction models often struggle with the nonlinearity and non-stationary characteristics of groundwater data. Our study leverages the capabilities of ST-GNNs to address these challenges in the Overbetuwe area, Netherlands. We utilize a comprehensive dataset encompassing 395 groundwater level time series and auxiliary data such as precipitation, evaporation, river stages, and pumping well data. The graph-based framework of our ST-GNN model facilitates the integration of spatial interconnectivity and temporal dynamics, capturing the complex interactions within the groundwater system. Our modified Multivariate Time Graph Neural Network model shows significant improvements over traditional methods, particularly in handling missing data and forecasting future groundwater levels with minimal bias. The model’s performance is rigorously evaluated when trained and applied with both synthetic and measured data, demonstrating superior accuracy and robustness in comparison to traditional numerical models in long-term forecasting. The study’s findings highlight the potential of ST-GNNs in environmental modeling, offering a significant step forward in predictive modeling of groundwater levels.

Abstract Background Andalusia is the second largest region in Spain, and it has developed a comprehensive mental health (MH) plan that encourages the consolidation of the balanced care model. However, its geographical and socioeconomic disparity is a great challenge for a community-based MH system. Both the assessment of the implementation of the MH plan and the development of new tools to support decision-making can be considered critical. Objectives The present study aims (i) to assess how the integration of different types of MH care may influence system performance and (ii) to check the performance evolution of the integration process geographically regarding the small MH areas of Andalusia. Methods The performance of the Andalusian MH system was assessed by combining Monte Carlo simulation, fuzzy inference and data envelopment analysis. The relative technical efficiency was the main performance indicator. Results A correct integration of appropriate types of MH care, according to population needs, increases the performance of the Andalusian MH system both from global and regional perspectives. The spatial representation (based on small MH areas) of the results highlights how the performance depends on specific geographical characteristics. By analyzing the identified spatial clusters, defined by different management patterns depending on user and socioeconomic characteristics, benchmark areas and areas for improvement can be studied to design evidence-informed policies and interventions. Conclusions A global analysis of MH system performance was carried out, including both the successive integration of different types of care and its spatial evolution. Although an appropriate integration of different types of MH care has a positive effect on the Andalusian MH system, this process has different profiles depending on specific geographically based user and socioeconomic characteristics. The balanced care model can be considered the paradigm for assessing the performance of a large and populated territory such as Andalusia, which has a community-based MH system. This methodological approach (performance assessment and spatial analysis) may be used as a guide for developing future evidence-informed policies and managerial interventions.

Abstract Background Elevated mammographic density (MD) for a woman’s age and body mass index (BMI) is an established breast cancer risk factor. The relationship of parity, age at first birth, and breastfeeding with MD is less clear. We examined the associations of these factors with MD within the International Consortium of Mammographic Density (ICMD). Methods ICMD is a consortium of 27 studies with pooled individual-level epidemiological and MD data from 11,755 women without breast cancer aged 35–85 years from 22 countries, capturing 40 country-& ethnicity-specific population groups. MD was measured using the area-based tool Cumulus. Meta-analyses across population groups and pooled analyses were used to examine linear regression associations of square-root (√) transformed MD measures (percent MD (PMD), dense area (DA), and non-dense area (NDA)) with parity, age at first birth, ever/never breastfed and lifetime breastfeeding duration. Models were adjusted for age at mammogram, age at menarche, BMI, menopausal status, use of hormone replacement therapy, calibration method, mammogram view and reader, and parity and age at first birth when not the association of interest. Results Among 10,988 women included in these analyses, 90.1% (n = 9,895) were parous, of whom 13% (n = 1,286) had ≥ five births. The mean age at first birth was 24.3 years (Standard deviation = 5.1). Increasing parity (per birth) was inversely associated with √PMD (β: − 0.05, 95% confidence interval (CI): − 0.07, − 0.03) and √DA (β: − 0.08, 95% CI: − 0.12, − 0.05) with this trend evident until at least nine births. Women who were older at first birth (per five-year increase) had higher √PMD (β:0.06, 95% CI:0.03, 0.10) and √DA (β:0.06, 95% CI:0.02, 0.10), and lower √NDA (β: − 0.06, 95% CI: − 0.11, − 0.01). In stratified analyses, this association was only evident in women who were post-menopausal at MD assessment. Among parous women, no associations were found between ever/never breastfed or lifetime breastfeeding duration (per six-month increase) and √MD. Conclusions Associations with higher parity and older age at first birth with √MD were consistent with the direction of their respective associations with breast cancer risk. Further research is needed to understand reproductive factor-related differences in the composition of breast tissue and their associations with breast cancer risk.

Abstract The NEREA (Naples Ecological REsearch for Augmented observatories) initiative aims to establish an augmented observatory in the Gulf of Naples (GoN), designed to advance the understanding of marine ecosystems through a holistic approach. Inspired by the Tara Oceans expedition and building on the scientific legacy of the MareChiara Long-Term Ecological Research (LTER-MC) site, NEREA integrates traditional physical, chemical, and biological measurements with state-of-the-art methodologies such as metabarcoding and metagenomics. Here we present the first 10 months of NEREA data, collected from April 2019 to January 2020, encompassing physico-chemical parameters, plankton biodiversity (e.g., microscopy and flow cytometry), prokaryotic and eukaryotic metabarcoding, a prokaryotic gene catalogue, and a collection of 3818 prokaryotic Metagenome-Assembled Genomes (MAGs). NEREA’s efforts produce a significant volume of multifaceted data, which enhances our understanding of marine ecosystems and promotes the development of scientific hypotheses and ideas.

Abstract In the last two decades, an exponentially growing number of meta-analyses (MAs) synthesize thousands of peer-reviewed studies on the environmental impacts of farming practices (FPs). This paper describes the iMAP-FP evidence library, a comprehensive dataset on the effects of 34 categories of FPs (such as agronomic practices, cropping and livestock systems, land management options and mitigation techniques) on 34 impacts including climate mitigation, soil health, environmental pollution, water use, nutrients cycling, biodiversity, and agricultural productivity. Through systematic screening, 570 MAs published since 2000 were selected and categorized according to the type of FP. We assessed their impacts, the geographic regions covered, and their quality. We extracted 3,811 effects and their statistical significance associated with sustainable FPs (intervention) compared to a control (typically conventional agriculture) across 223 different intervention-control pairs. Our dataset is accompanied with an online free-access library, which includes a catalogue of synthetic reports summarizing the available evidence on each evaluated FP.

Acid mine drainage severely affects metallic materials due to the high acidity and oxidising capacity of these lixiviates. A study was carried out to evaluate the time evolution of the mechanical properties of AISI 1020 carbon steel and AW6060 aluminium in contact with acid mine drainage. Weight loss, fatigue and tensile strength were evaluated in two different scenarios, one involving erosion corrosion (dynamic scenario) and the other involving chemical corrosion only (static scenario). Over 80 days of exposure in a static scenario, weight loss is almost 2% for aluminium and 0.5% for steel, fatigue strength is reduced by 28% for steel and ultimate tensile strength is reduced by almost 5% for aluminium and by 2.5% for steel. In a dynamic scenario, the weight loss after 4 days of exposure is 30–35% for both materials, the fatigue strength is reduced by almost 50% for steel, the ultimate tensile strength is reduced by 33% for aluminium and by almost 5% for steel. Acid drainage causes an increase in brittleness and a decrease in stiffness of these materials, much more rapidly in a dynamic environment favoured by the effects of erosion corrosion.

Background: Tirbanibulin is approved for actinic keratosis (AK) field treatment up to 25 cm2. However, AK often affects larger areas; thus, AK treatments for larger fields are needed. Objective: Evaluate the safety and tolerability of tirbanibulin when applied to a field of approximately 100 cm2. Methods: Phase 3, multicenter, open-label, single-arm study among adult patients having a treatment field on the face or balding scalp of approximately 100 cm2 with 4-12 AKs. Patients received tirbanibulin to cover the treatment field once daily (5 consecutive days). Safety was assessed by evaluating treatment emergent adverse events and tolerability by composite score of 6 local tolerability signs (LTS). Results: A total of 105 patients were included. The most common LTS were erythema (96.1%) and flaking/scaling (84.4%), being mostly mild-to-moderate severity, and resolved/returned to or close to baseline by Day 29. The only severe LTS were erythema (5.8%) and flaking/scaling (8.7%). Most frequent treatment emergent adverse events were application site pruritus (10.5%) and application site pain (8.6%). Mean total number of AKs decreased from 7.7 AKs at baseline to 1.8 AKs at Day 57. Mean percent of change (reduction) from baseline in lesion count was 77.8% at Day 57. Limitations: No control group. No long-term follow-up. Conclusion: Safety and tolerability profiles in patients treated with tirbanibulin up to 100 cm2 were consistent with those previously reported over smaller field. Tirbanibulin could be used on a larger field (>25 cm2).

The Anglo-Arabian horse breed (AA) is the result of crossing between Thoroughbred and Arabian horses renowned for versatility in show-jumping and racing. Southwest France and Sardinia in Italy are considered the historical nucleus of European AA breeding. Since little is known on genetic variability in the AA breed, especially those bred in the Sardinia region, this study investigates: i) inbreeding levels via pedigree and SNP genotyping; ii) runs of homozygosity (ROH) and selection signatures; iii) effective population size; and iv) distinctiveness of AA compared to Arabian and Thoroughbred horses. The ROH revealed an excessive amount of homozygosity, with a high kurtosis value observed in several chromosomes and an average inbreeding based on ROH of 21.1%. This latter value is higher compared to what was found based on pedigree data, highlighting the importance of complete pedigree records when estimating inbreeding based on genealogical data. The genomic inbreeding in AA horses was higher compared to other Italian horse breeds but lower than what was found in pure Thoroughbred and Arabian horses. This result suggests that the selection process for AA horses, may have prioritised racing ability over breed preservation which is the main goal in most local Italian breeds. The reduction in effective population size found in the latest 20 generations corroborates the potential presence of genetic diversity reduction due to selection in the AA breed. Remarkably, a large ROH island was identified on ECA17, which overlapped with two QTLs associated with racing performance.

Abstract Background Traumatic brain injury (TBI) and repetitive head impacts (RHI) have been linked to increased risk for multiple types of neurodegenerative disease, higher dementia risk, and earlier age of dementia symptom onset, suggesting transdiagnostic implications for later-life brain health. Frontotemporal dementia (FTD) and primary progressive aphasia (PPA) represent a spectrum of clinical phenotypes that are neuropathologically diverse. FTD/PPA diagnoses bring unique challenges due to complex cognitive and behavioral symptoms that disproportionately present as an early-onset dementia (before age 65). We performed a detailed characterization of lifetime head trauma exposure in individuals with FTD and PPA compared to healthy controls to examine frequency of lifetime TBI and RHI and associated clinical implications. Methods We studied 132 FTD/PPA (age 68.9 ± 8.1, 65% male) and 132 sex-matched healthy controls (HC; age 73.4 ± 7.6). We compared rates of prior TBI and RHI (contact/collision sports) between FTD/PPA and HC (chi-square, logistic regression, analysis of variance). Within FTD/PPA, we evaluated associations with age of symptom onset (analysis of variance). Within behavioral variant FTD, we evaluated associations with cognitive function and neuropsychiatric symptoms (linear regression controlling for age, sex, and years of education). Results Years of participation were greater in FTD/PPA than HC for any contact/collision sport (8.5 ± 6.7yrs vs. 5.3 ± 4.5yrs, p = .008) and for American football (6.2yrs ± 4.3yrs vs. 3.1 ± 2.4yrs; p = .003). Within FTD/PPA, there were dose-dependent associations with earlier age of symptom onset for TBI (0 TBI: 62.1 ± 8.1, 1 TBI: 59.9 ± 6.9, 2 + TBI: 57.3 ± 8.4; p = .03) and years of American football (0yrs: 62.2 ± 8.7, 1-4yrs: 59.7 ± 7.0, 5 + yrs: 55.9 ± 6.3; p = .009). Within bvFTD, those who played American football had worse memory (z-score: -2.4 ± 1.2 vs. -1.4 ± 1.6, p = .02, d = 1.1). Conclusions Lifetime head trauma may represent a preventable environmental risk factor for FTD/PPA. Dose-dependent exposure to TBI or RHI influences FTD/PPA symptom onset and memory function in bvFTD. Clinico-pathological studies are needed to better understand the neuropathological correlates linking RHI or TBI to FTD/PPA onset and symptoms.

Abstract The pandemic marked the beginning of an era of dynamic and rapid changes in the diagnosis of respiratory infections. Herein we describe Legionnaires’ disease trend in the years 2016–2023 in a large Italian hospital showing how improvements in diagnostic algorithms impact on its detection.

Abstract Background Goats were domesticated in the Fertile Crescent about 10,000 years before present (YBP) and subsequently spread across Eurasia and Africa. This dispersal is expected to generate a gradient of declining genetic diversity with increasing distance from the areas of early livestock management. Previous studies have reported the existence of such genetic cline in European goat populations, but they were based on a limited number of microsatellite markers. Here, we have analyzed data generated by the AdaptMap project and other studies. More specifically, we have used the geographic coordinates and estimates of the observed (Ho) and expected (He) heterozygosities of 1077 European, 1187 African and 617 Asian goats belonging to 38, 43 and 22 different breeds, respectively, to find out whether genetic diversity and distance to Ganj Dareh, a Neolithic settlement in western Iran for which evidence of an early management of domestic goats has been obtained, are significantly correlated. Results Principal component and ADMIXTURE analyses revealed an incomplete regional differentiation of European breeds, but two genetic clusters representing Northern Europe and the British-Irish Isles were remarkably differentiated from the remaining European populations. In African breeds, we observed five main clusters: (1) North Africa, (2) West Africa, (3) East Africa, (4) South Africa, and (5) Madagascar. Regarding Asian breeds, three well differentiated West Asian, South Asian and East Asian groups were observed. For European and Asian goats, no strong evidence of significant correlations between Ho and He and distance to Ganj Dareh was found. In contrast, in African breeds we detected a significant gradient of diversity, which decreased with distance to Ganj Dareh. Conclusions The detection of a genetic cline associated with distance to the Ganj Dareh in African but not in European or Asian goat breeds might reflect differences in the post-domestication dispersal process and subsequent migratory movements associated with the management of caprine populations from these three continents.

Abstract Background Metabolic syndrome (MetS) is a cluster of medical conditions and risk factors correlating with insulin resistance that increase the risk of developing cardiometabolic health problems. The specific criteria for diagnosing MetS vary among different medical organizations but are typically based on the evaluation of abdominal obesity, high blood pressure, hyperglycemia, and dyslipidemia. A unique, quantitative and independent estimation of the risk of MetS based only on quantitative biomarkers is highly desirable for the comparison between patients and to study the individual progression of the disease in a quantitative manner. Methods We used NMR-based metabolomics on a large cohort of donors (n = 21,323; 37.5% female) to investigate the diagnostic value of serum or serum combined with urine to estimate the MetS risk. Specifically, we have determined 41 circulating metabolites and 112 lipoprotein classes and subclasses in serum samples and this information has been integrated with metabolic profiles extracted from urine samples. Results We have developed MetSCORE, a metabolic model of MetS that combines serum lipoprotein and metabolite information. MetSCORE discriminate patients with MetS (independently identified using the WHO criterium) from general population, with an AUROC of 0.94 (95% CI 0.920–0.952, p

Abstract Background Hemodynamic classification of pulmonary hypertension (PH) has important clinical implications. However, only a few echocardiographic variables have been used to hemodynamically classify PH in dogs. Objective To evaluate the echocardiographic pulmonary to left atrial ratio index (ePLAR) in dogs with PH. Animals Forty‐six dogs with intermediate to high probability of PH. Methods Cross‐sectional study. Variables were compared between dogs with precapillary PH [PrePH (n = 24)] vs postcapillary PH [PostPH (n = 22)], and with combined PH [CombPH (n = 14)] vs isolated PH [IsoPH (n = 8)] using the t‐, Mann‐Whitney, Pearson's Chi, or Fisher's exact test. The receiver operating characteristic curve and Youden index were used to identify the optimal ePLAR cutoff value to differentiate among the groups, intraclass correlation coefficients (ICC) were used to determine the reliability of measurements. Results The mean (SD) ePLAR of the PrePH was higher than that of the PostPH group [0.36 (0.13) vs 0.26 (0.09), respectively; P = .005]. The median (interquartile range) ePLAR of the CombPH was higher than that of the IsoPH subgroup [0.29 (0.24‐0.38), vs 0.20 (0.16‐0.23), respectively; P = .001]. The best cutoff value of ePLAR for identifying IsoPH was

Highlights: • A multi-approach methodology was used for a thorough examination of a prehistoric cup decorated with engravings, found at the Bronze Age settlement of Filo Braccio in Filicudi Island (Messina). • Photogrammetry and near-infrared (NIR) imaging were combined to create a metrically correct digital replica (with switchable texture); 3D and 2D views were exported to study the vessel’s morphology and decorations. • To enrich the visiting experience, the 3D model was integrated into a web-based viewer, and enriched with informative annotation, making it easily accessible through mobile devices and computers. Abstract: This paper presents a multidisciplinary study combining photogrammetry, near-infrared (NIR) imaging and archaeological analysis to analyse a 1900-1800 BC engraved cup, found at the Bronze Age site of Filo Braccio in Filicudi, Aeolian Islands, Italy. The artefact is unique within the contemporary ‘Capo Graziano’ culture, featuring a rare complex figural scene engraved along the exterior walls; the “scene” provides insights into the prehistoric culture of Filicudi and the Aeolian Islands. The study focused on generating an accurate three-dimensional (3D) model to i) support archaeological research on the artefact's engravings and ii) create engaging digital media for remote and on-site visitors. Photogrammetry used high-resolution photographs taken around the object and control points for metric accuracy assessment. This study also utilises NIR and visible light imaging to examine the engraved cup. The photogrammetric workflow provided a realistic 3D model textured with both visible and NIR data: the 3D model enabled to improve the reading of the engraved scene, revealing horizontal registers of figures, while NIR imaging highlighted material inhomogeneity. The resulting 3D model achieved a high level of detail, with 4381407 faces and a root mean square (RMS) reprojection error of approximately 3.9 μm. The NIR imaging revealed additional surface details not visible in the standard photographs. For dissemination, the optimised 3D model was uploaded to Sketchfab with informative annotations, enabling remote study and cultural promotion of the artefact. This multi-approach methodology offers a valuable tool for comprehensive artefact documentation and analysis, providing new insights into the artefact's complex figural scene.

Abstract Future trajectories of agricultural productivity need to incorporate environmental targets, including the reduction of pesticides use. Landscape features supporting natural pest control (LF-NPC) offer a nature-based solution that can serve as a partial substitute for synthetic pesticides, thereby supporting future productivity levels. Here, we introduce a novel approach to quantify the contribution of LF-NPC to agricultural yields and its associated economic value to crop production in a broad-scale context. Using the European Union as case study, we combine granular farm-level data, a spatially explicit map of LF-NPC potential, and a regional agro-economic supply and market model. The results reveal that farms located in areas characterized by higher LF-NPC potential experience lower productivity losses in a context of reduced synthetic pesticides use. Our analysis suggests that LF-NPC reduces yield gaps on average by four percentage points, and increases income by a similar magnitude. These results highlight the significance of LF-NPC for agricultural production and income, and provide a valuable reference point for farmers and policymakers aiming to successfully invest in landscape features to achieve pesticides reduction targets.

Abstract The last decades have witnessed huge efforts devoted to deciphering the pathological mechanisms underlying Alzheimer’s Disease (AD) and to testing new drugs, with the recent FDA approval of two anti-amyloid monoclonal antibodies for AD treatment. Beyond these drug-based experimentations, a number of pre-clinical and clinical trials are exploring the benefits of alternative treatments, such as non-invasive stimulation techniques on AD neuropathology and symptoms. Among the different non-invasive brain stimulation approaches, transcranial alternating current stimulation (tACS) is gaining particular attention due to its ability to externally control gamma oscillations. Here, we outline the current knowledge concerning the clinical efficacy, safety, ease-of-use and cost-effectiveness of tACS on early and advanced AD, applied specifically at 40 Hz frequency, and also summarise pre-clinical results on validated models of AD and ongoing patient-centred trials.

Our previous work demonstrated the presence of lead (Pb) and cadmium (Cd) contamination in cow milk (CM) and soy beverages (SBs) in Portugal. These metals share carcinogenic mechanisms, suggesting at least additive effects. Our goals were to assess carcinogenic risks from Pb and Cd intake detected in various CM and SB brands on the Portuguese market and to determine the relative contributions of Pb and Cd. Furthermore, we modeled different consumption scenarios for various age/body weight groups to estimate cumulative Excess Lifetime Carcinogenic Risk (ELCR). ELCR was computed by multiplying chronic daily intake by a cancer slope factor for each metal, with an ELCR > 1 × 10−4 indicating carcinogenic risk. Five CM and three SB brands posed cancer risks in children, with the highest values at 1.75 × 10−4 and 9.12 × 10−5, respectively; Pb had mean relative contributions of 87.8 ± 3.1% in CM and 54.9 ± 12.1% in SB. Carcinogenic risks were observed for children, adolescents, and adults in several CM or SB consumption scenarios, albeit at levels above typical Portuguese intakes. Strict monitoring of metal levels, such as Pb and Cd, is advised because CM is a component of many foods, including baby food.

Abstract Detection of high glycated hemoglobin (A1c) is associated with worse postoperative outcomes, including predisposition to develop systemic and local infectious events. Diabetes and infectious Outcomes in Cardiac Surgery (DOCS) study is a retrospective case–control study aimed to assess in DM and non-DM cardiac surgery patients if a new screening and management model, consisting of systematic A1c evaluation followed by a specialized DM consult, could reduce perioperative infections and 30-days mortality. Effective July 2021, all patients admitted to the cardiac surgery of IRCCS ISMETT were tested for A1c. According to the new protocol, glucose values of patients with A1c ≥ 6% or with known diabetes were monitored. The diabetes team was activated to manage therapy daily until discharge or provide indications for the diagnostic-therapeutic process. Propensity score was used to match 573 patients managed according to the new protocol (the Screen+ Group) to 573 patients admitted before July 2021 and subjected to the traditional management (Screen−). Perioperative prevalence of infections from any cause, including surgical wound infections (SWI), was significantly lower in the Screen+ as compared with the Screen− matched patients (66 [11%] vs. 103 [18%] p = 0.003). No significant difference was observed in 30-day mortality. A1c analysis identified undiagnosed DM in 12% of patients without known metabolic conditions. In a population of patients undergoing cardiac surgery, systematic A1c evaluation at admission followed by specialist DM management reduces perioperative infectious complications, including SWI. Furthermore, A1c screening for patients undergoing cardiac surgery unmasks unknown DM and enhances risk stratification.

Un importante movimiento inspirado en la visión hedonista de la felicidad ha llevado a convertir el concepto en una material medible para las construcción de políticas nacionales e institucionales de felicidad, buscando aumentarla a partir de variables materiales y psicológicas. Este artículo revisa las bases de esta aproximación contrastándola con la visión eudaimónica de felicidad, la cual se centra más en la realización espiritual. Metodológicamente, se observan y comparan experiencias institucionales en la literatura, incluyendo el Índice Nacional de felicidad. También se aplica y se analiza una encuesta con escala de Lickert, con el fin de identificar hasta qué medida la narrativa hedonista puede permitir o no el desarrollo de la visión eudaimónica. Se concluye que, por su naturaleza, no es posible hasta el momento crear un modelo ponderable que concilie la visión eudaimónica de felicidad en la política institucional. El debate abierto implica una revisión epistemológica de la pertinencia científica y filosófica del positivismo, la psicología positiva y la tensión irresuelta entre razón y emoción.

Pediatric Hodgkin lymphoma (HL) is a curable disease for more than 90% of children and adolescents in high income countries. However, similar results cannot be achieved, particularly for advanced disease, in low- and middle-income countries (LMICs), where challenging socioeconomic realities and the consequent scarcity of local resources heavily impact on the treatment and patients’ outcome. Information regarding the management and outcome of pediatric HL in LMICs is still limited. In this narrative review, we summarize the results reported in the literature so far and discuss the critical key points that have emerged from this overview.

Introdução: A sífilis é uma doença de caráter infecto-contagioso capaz de acometer neonatos, sendo a segunda maior causa-morte de natimortos. É uma moléstia de diagnóstico simples no decorrer do pré-natal. Objetivo: Estudar as características epidemiológicas de pessoas que gestam acometidas por sífilis gestacional no Brasil no período de 2018-2022. Método: Estudo epidemiológico transversal, produzido com dados do Sistema de Informação Ambulatorial do DATASUS, considerando divisões por ano, região, escolaridade e tipo de sífilis. Resultados: Durante o período analisado, foram confirmados 352.382 casos de sífilis em gestantes. A região mais acometida foi a região Sudeste, com 160.776 (33,13%) notificações. O ano de maior incidência foi em 2022, com o total de 83.033 (23,56%) casos. A faixa etária mais acometida é o intervalo entre 20-39 anos (262.900; 74,60%), seguido de 15-19 anos (79.027; 22,42%). Com relação à classificação clínica da sífilis, as mais prevalentes entre as gestantes foram a latente e a primária, totalizando 138.312 (39,24%) e 89.468 (25,38%) casos, respectivamente. Dispensando-se os 1.440 casos Ignorados/Branco, nota-se, dentre os 4.853 casos de sífilis em gestantes em que houve registro da escolaridade, maior incidência em gestantes de ensino médio completo (1.388; 28,60%). Conclusão: Diante do cenário epidemiológico e do acometimento apresentados pela sífilis em gestantes, as maiores incidências foram: o ano de 2022, a região Sudeste, a faixa etária de 20-39 anos e apresentando, principalmente, classificação clínica latente ou primária. A partir do exposto, demonstra-se a necessidade de aprimorar políticas públicas voltadas para a conscientização acerca das IST's, como, também a capacitação dos profissionais de saúde para lidar com os recortes etário, escolar e regional apresentados. Esse estudo possui limitações ao utilizar dados secundários, fato demonstrado no registro dos números elevados de Ign/Branco, de modo a ratificar a indispensabilidade de uma notificação mais apurada por parte dos profissionais da saúde.

Introdução: A PrEP (Profilaxia Pré-Exposição) é uma estratégia que reduz as chances de contágio pelo vírus do HIV, por via sexual, em 99%. Essa recente tecnologia disponível no SUS se mostrou importante meio para a contenção da epidemia do vírus. Nesse sentido, é importante compreender o perfil epidemiológico do usuário a fim de se criarem estratégias para ampliação da cobertura dessa política pública para grupos populacionais negligenciados. Objetivo: Analisar o perfil dos usuários da PrEP no Brasil entre 2018 e 2023. Método: Estudo quantitativo-descritivo que utilizou dados do Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis (DATHI). Teve como objetivo analisar e descrever o perfil desses usuários a partir de dados como escolaridade, orientação sexual/identidade de gênero, idade e raça. Resultados: No período estudado, houve aumento de 1.160,96% do número de dispensações, com 277.008 em 2023, mas o perfil do usuário se manteve estável. Em relação à escolaridade, o grupo com mais de 12 anos de estudo representa, desde 2018, a grande parcela dos usuários, com discreta redução de 76,82% em 2018 para 71,73% em 2023. Quanto à orientação sexual/identidade de gênero, o grupo de homens cisgênero que fazem sexo com homens esteve no topo durante o período, variando entre 82% em 2023 e 85,6% em 2021; o grupo de mulheres cisgênero manteve-se na segunda posição de 2018 (8,1%) a 2022 (5,7%), sendo ultrapassado pelo recorte de homens heterossexuais cisgênero em 2023, que representou 6,5% contra 5,8% de mulheres cisgênero. A faixa etária mais representativa é de 30 a 39 anos, 42,1% em 2023. Houve redistribuição do impacto de cada faixa etária, com diminuição percentual dos usuários de 30 anos ou mais e aumento percentual daqueles abaixo de 30 anos. Os recortes raciais mantiveram-se estáveis no período, com a raça branca/amarela representando 55,54% dos usuários em 2023. Conclusão: Embora a PrEP tenha se disseminado no período, o perfil do usuário majoritário pouco mudou, representado por pessoas brancas/amarelas, mais escolarizadas, na faixa etária de 30 a 39 anos e de homens cisgênero que fazem sexo com homens. Assim, a menor adesão entre pessoas de menor instrução, mais jovens, que não sejam homens cisgênero que fazem sexo com homens e das raças parda, preta e indígena representa um problema de acesso à estratégia, já que essa política pública deve contemplar outros perfis sociais, sobretudo os mais marginalizados e os que tradicionalmente não são público-alvo desse método.

Introdução: A PrEP (Profilaxia Pré-Exposição) é uma medida preventiva que reduz drasticamente as chances de infecção pelo vírus HIV, pelo contato sexual, com uma eficácia de até 99%. Essa recente estratégia disponível no SUS tem se mostrado uma ferramenta essencial para conter a disseminação do HIV. Nesse sentido, é importante compreender como esse método tem se distribuído pelas regiões do Brasil. Objetivo: Analisar os dados da distribuição regional da dispensação da PrEP no Brasil entre 2018 e 2023. Método: Estudo ecológico utilizando dados do Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis (DATHI) em comparação com o Censo Demográfico do Brasil de 2022 publicado pelo Instituto Brasileiro de Geografia e Estatística. Foi avaliada a distribuição das dispensações de PrEP e das Unidades Dispensadoras de Medicação (UDMs) por região brasileira no período de 2018 a 2023. Resultados: Ocorreu um aumento progressivo no número total de dispensações da PrEP no Brasil entre 2018 e 2023, representando um crescimento de 1.160,96%, com uma redução em todas as regiões no período de 2019 e 2020. Em relação ao número de UDMs, observou-se um crescimento de 630,68% no país. Na dispensação por região, existe uma desproporcionalidade em relação à distribuição populacional. Em 2022, o Sudeste representava 41,78% da população brasileira, abrangendo 58,83% das dispensações da PrEP. No mesmo período, as regiões Norte e Nordeste representavam 8,55% e 26,91% da população brasileira e apresentavam apenas 4,69% e 11,23% das dispensações, respectivamente. No período analisado, a região Sudeste manteve-se com o maior número de dispensações de PrEP, mas com uma pequena redução da relevância dessa região em relação aos números totais nos últimos dois anos. Destacaram-se as dispensações no Centro-oeste, que cresceram 2.076,77% entre 2018 e 2023. Conclusão: A PrEP tem se disseminado no Brasil como importante estratégia de prevenção do HIV. Todavia, observou-se um descompasso entre a distribuição populacional de cada região e a distribuição do número de dispensações e de UDMs, o que indica que a estratégia pode estar muito centralizada em locais de melhores índices econômicos e educacionais, o que precisa ser superado. A pandemia de Covid-19 explica a desaceleração da disseminação da política em 2020.

Introdução: A população em situação de rua (PSR) apresenta um risco de adoecer por tuberculose (TB) 54 vezes maior do que a população em geral, tendo em vista o baixo acesso ao sistema de saúde, bem como a insegurança alimentar e sanitária, a violência e a discriminação enfrentada diariamente que prejudicam seu acesso e capacidade de aderir ao cuidado necessário. Ademais, a PSR também está mais sujeita a ter desfechos negativos no tratamento da doença, incluindo perda de acompanhamento e óbito. Objetivo: Analisar o perfil epidemiológico de pacientes confirmados com TB da população em situação de rua nos últimos cinco anos (2018-2023). Método: Estudo ecológico, com casos confirmados de TB do Sistema de Informação de Agravos de Notificação (SINAN). Foram incluídos casos de TB na PSR, especificando o ano de notificação, região, sexo, faixa etária, uso de tabaco, uso de álcool, TB associado a AIDS e forma de TB. Resultados: Foram registrados 24.412 casos de TB na PSR. A região mais acometida, com casos confirmados, foi a região Sudeste, com 12.595 (51,59%). O ano com maior incidência de casos foi em 2023, com 5.686 (23,15%). A faixa etária mais acometida é o intervalo de 20-39 anos (11.765; 48,26%), seguido de 40-59 (10.853; 44,52%). O sexo mais acometido é o masculino com 19.846 casos, o equivalente a 81,30%. Com relação a forma de TB mais prevalente, entre a população em situação de rua, é a forma pulmonar, com 22.730 casos (93,11%), seguida da extrapulmonar com 844 casos (3,46%). Outros pontos analisados, foi a associação de TB e álcool, existente em 13.646 casos (55,90%); a associação de TB e fumo ocorreu em 12.540 casos (55,33%). No tocante à coinfecção de AIDS e TB ocorreu em 22,79%, em contraste com 70,13% dos casos nos quais não havia a infecção simultânea. Conclusão: Apesar de existirem políticas públicas direcionadas às pessoas em situação de rua, faz-se evidente, a partir dos dados apresentados, a necessidade de aprimorá-las, a fim de combater e controlar efetivamente a TB na PSR. Para isso, é urgente que a assistência em saúde enxergue as complexidades e vulnerabilidades enfrentadas por essa população, de forma que seja traçada uma efetiva ação de abordagem e acolhimento da PSR, a fim de promover o diagnóstico precoce e o acompanhamento até o fim do tratamento necessário.

BackgroundChildhood obesity has become a significant public health concern over the past 2 decades, posing multifactorial challenges, including modifiable factors like dietary habits, physical activity, screen time, and sleeping habits. Prevention efforts require a comprehensive approach comprising educational interventions, collaboration among multidisciplinary teams, and community engagement. Since schools play a central role in children's lives, they are the ideal setting for promoting healthy habits. ObjectiveThe LIVELY (Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle) study will assess the prevalence of overweight and obesity in primary school children and identify contributing factors within families. Additionally, it aims to implement and evaluate a multidimensional, multidisciplinary intervention to foster a sustainable and healthy lifestyle, ultimately working toward preventing obesity in school-aged children. MethodsDuring the school year, each class will be individually involved in a multidimensional educational intervention covering the topics of healthy, sustainable nutrition and lifestyle. Children will also participate in a multimedia lab where they will create an animated cartoon. The lectures will engage them through various methods, including direct instructions, games, and drawing activities, to stimulate and enhance their learning and involvement. ResultsData collection began in October 2023 and will last until the end of October 2024. A sample of 227 children from 14 classes was included in the study. The mean age was 8.9 (SD 1.2) years, and 48% (n=110) were males. Among the overall sample, 18.1% (n=41; 95% CI 13.7%-23.7%) were overweight, while 5.3% (n=12; 95% CI 3%-9%) had obesity. Males had a higher prevalence of obesity than females (9.1%, n=10 vs 1.7%, n=3, P=.03, respectively). Otherwise, the prevalence of central obesity was similar between the two (P=.329). Data analysis and the presentation of the complete results will be available after the end of 2024. ConclusionsThe study could lead to the structuring of an educational intervention model in school settings aimed at preventing childhood obesity. Moreover, it could help raise awareness of childhood obesity and help prevent this public health issue. Trial RegistrationClinicalTrials.gov NCT05966051; https://clinicaltrials.gov/study/NCT05966051 International Registered Report Identifier (IRRID)DERR1-10.2196/57509

Patients present a wide range of clinical severities in response severe acute respiratory syndrome coronavirus 2 infection, but the underlying molecular and cellular reasons why clinical outcomes vary so greatly within the population remains unknown. Here, we report that negative clinical outcomes in severely ill patients were associated with divergent RNA transcriptome profiles in peripheral immune cells compared with mild cases during the first weeks after disease onset. Protein–protein interaction analysis indicated that early-responding cytotoxic natural killer cells were associated with an effective clearance of the virus and a less severe outcome. This innate immune response was associated with the activation of select cytokine–cytokine receptor pathways and robust Th1/Th2 cell differentiation profiles. In contrast, severely ill patients exhibited a dysregulation between innate and adaptive responses affiliated with divergent Th1/Th2 profiles and negative outcomes. This knowledge forms the basis of clinical triage that may be used to preemptively detect high-risk patients before life-threatening outcomes ensue.

Agriculture-dependent developing Southeast Asian countries need to assess residual pesticides in receiving water from agricultural runoff as one of the basis for the establishment of baseline data. Monitoring residual pesticides in surface water is challenging due to pesticides’ irregular/intermittent emission and low solubility in water. To address the challenge of pesticide assessment, passive samplers composed of silicon rubber sheets (SR) and speedisk (SD) were used to capture hydrophobic and hydrophilic organic pesticides and other organic pollutants, respectively. Samplers were submerged uninterruptedly for at least 30 days in three selected sites in Can Tho River, Mekong Delta, Vietnam, and Cagayan de Oro River Basin, Philippines, for 2 years. Passive samplers (SR spiked with 232 pesticides) captured 83 and 69 residual pesticides at concentrations of ng/L levels in Vietnam and the Philippines, respectively, which is unattainable through conventional grab sampling methods. Trace concentrations of banned compounds such as OCPs, PCBs, and PAHs were also detected at pg./L levels. The success of this alternative methodology can be attributed to the combination of passive samplers tailored for nonpolar (water-insoluble) and polar (water-soluble) organic contaminants coupled with sensitive analytical instruments, including GCMSMS and LCMSMS.

Legionnaires' disease (LD) is a serious type of pneumonia, typically contracted by susceptible people through the inhalation of aerosols contaminated with Legionella pneumophila (Lp). In this report, the first case of coinfection with Lp–Bordetella bronchiseptica (Bb) is described. A possible source of the Lp infection may be the hotel in Paris (France) where the patient had stayed before developing the symptoms. The Bb infection may have been transmitted by the dog with which he had constant contact, although this has not been proven.

An important dimension to understand the student learning process is the professional identity of teachers, which is conceptualized as a continuous process of construction and reconstruction. In this process, teachers define and assume their roles in a specific educational context that is characterized by tensions, adjustments, and transformations. This study focuses on understanding the professional identity of higher education teachers, a field characterized by constant evolution and demands. The personal characteristics of this identity are explored, including experiences and biographical representations, as well as its interrelationship with the institutional environment. Using a qualitative interpretive approach, six teachers recognized for their pedagogical innovation and educational commitment were interviewed. The results reveal outstanding motivation and responsibility in educational work, but also tensions between personal identity and the work context, reflected in the perception of low recognition and the importance of institutional leadership. The teachers show a critical and reflective view of their work, influenced by childhood experiences that impact their conceptions of educational justice and equity. To conclude, the common characteristics of professional identity in higher education highlight the need to integrate them into professional development. The article advocates for the design of more personalized training programs and the promotion of continuous learning among peers as key elements to strengthen this identity and improve pedagogical practice.

ABSTRACT Limiting the availability of transition metals at infection sites serves as a critical defense mechanism employed by the innate immune system to combat microbial infections. Pseudomonas aeruginosa exhibits a remarkable ability to thrive in zinc-deficient environments, facilitated by intricate cellular responses governed by numerous genes regulated by the zinc-responsive transcription factor Zur. Many of these genes have unknown functions, including those within the predicted PA2911-PA2914 and PA4063-PA4066 operons. A structural bioinformatics investigation revealed that PA2911-PA2914 comprises a TonB-dependent outer membrane receptor and inner membrane ABC-permeases responsible for importing metal-chelating molecules, whereas PA4063-PA4066 contains genes encoding a MacB transporter, likely involved in the export of large molecules. Molecular genetics and biochemical experiments, feeding assays, and intracellular metal content measurements support the hypothesis that PA2911-PA2914 and PA4063-PA4066 are engaged in the import and export of the pyochelin-cobalt complex, respectively. Notably, cobalt can reduce zinc demand and promote the growth of P. aeruginosa strains unable to import zinc, highlighting pyochelin-mediated cobalt import as a novel bacterial strategy to counteract zinc deficiency. These results unveil an unexpected role for pyochelin in zinc homeostasis and challenge the traditional view of this metallophore exclusively as an iron transporter.IMPORTANCEThe mechanisms underlying the remarkable ability of Pseudomonas aeruginosa to resist the zinc sequestration mechanisms implemented by the vertebrate innate immune system to control bacterial infections are still far from being fully understood. This study reveals that the Zur-regulated gene clusters PA2911-2914 and PA4063-PA4066 encode systems for the import and export of cobalt-bound pyochelin, respectively. This proves to be a useful strategy to counteract conditions of severe zinc deficiency since cobalt can replace zinc in many proteins. The discovery that pyochelin may contribute to cellular responses to zinc deficiency leads to a reevaluation of the paradigm that pyochelin is a siderophore involved exclusively in iron acquisition and suggests that this molecule has a broader role in modulating the homeostasis of multiple metals.

The demands for Li-ion batteries (LIBs) have recently increased exponentially. They are used in a multitude of applications including electric vehicles (EVs), Energy Storage Systems (ESS) and consumer electronics. However, their chemical composition, high energy content and behaviour under abuse conditions pose a significant risk to safety, human health and the environment. This risk is particularly pronounced with the amount of active materials, especially the organic electrolyte and consequently, with the number of cells constituting the battery. To mitigate the risk, critical points throughout the entire life cycle of a lithium battery must be identified. For this purpose, the analysis of accidents occurring around the world acquires a fundamental importance. The evaluation of the main risks associated with the transport, use and storage of LIBs would allow the improvement of specific prevention measures to reduce the risk of fire and explosion during their use and their storage. Additionally, the improvement of safety procedures to manage accidents involving lithium ion batteries should be considered. Furthermore, it enables the updating of legal and technical standards and the development of more reliable storage systems. The aim of this study is to enhance current knowledge on the factors that may trigger fire involving LIBs through the analysis of accidents and recall databases analysis. An Italian database has been developed which includes data on accidents that occurred during the normal use of batteries, as well as those that occurred in storage facilities, during transport and in the disposal of batteries. One example of the reconstruction of data necessary to enhance a database is presented in this work.

La comunicación es la principal herramienta para una adecuada socialización. Una comunicación asertiva, o lograr expresar pensamientos y sentimientos de forma respetuosa, favorece las relaciones interpersonales, la satisfacción vital, la confianza en uno mismo, la expresividad y la espontaneidad, que tan difíciles son de lograr a veces para las personas con discapacidad intelectual. Este estudio, a través del cuestionario de asertividad del proyecto de salud mental “Promoviendo la adaptación saludable de nuestros adolescentes”, aplicado a diecinueve estudiantes con discapacidad intelectual del programa formativo Todos Somos Campus, de la Universidad de Murcia, España, ha investigado acerca del nivel de asertividad de estos jóvenes y la autopercepción sobre su estilo comunicativo (asertivo, pasivo o agresivo). Los resultados muestran que los estudiantes presentan un nivel de asertividad medio, con diferencias entre quienes se identifican con un estilo de comunicación asertivo y quienes creen tener una comunicación pasiva. Todo ello no hace más que continuar evidenciando la importancia de formar en asertividad y habilidades de comunicación, dado que, junto con otras, forman los pilares de las habilidades sociales de toda persona y repercuten directamente en su calidad de vida.

IntroductionBisphenol A (BPA) is a common contaminant widely used in many industrial sectors. Because of its wide use and dispersion, it can be accumulated in living human bodies through both oral assumption and nondietary routes. BPA exhibits hormone-like properties, falling under the class of endocrine disruptors; therefore, it can alter relevant physiological functions. In particular, in women, it can affect folliculogenesis and therefore reproduction, contributing not only to infertility, but also to endometriosis and premature puberty.MethodsWe conducted a multicenter study on 91 women undergoing a first in vitro fertilization (IVF) treatment in the Campania region (Southern Italy). We investigated the presence and concentration of BPA in serum and follicular fluids to assess the effects of airborne BPA contamination. The analysis was conducted on 32 women living in a low environmental impact (LEI) area, from the Sele Valley River and Cilento region, and 59 women living in a high environmental impact (HEI) area, the so-called “Land of Fires”, a highly contaminated territory widely exposed to illegal waste practices.ResultsA higher average BPA content in both blood serum and follicular fluid was revealed in the HEI group when compared with the LEI group. In addition, we revealed higher average BPA content in blood serum than in folliclular fluid in the HEI area, with opposite average content in the two fluids in the LEI zone. In addition, our results also showed a lack of correlation between BPA content in follicular and serum fluids both in the overall population and in the HEI and LEI groups, with peculiar trends in different subsets of women.ConclusionFrom our results, we revealed a heterogeneity in the distribution of BPA content between serum and follicular fluid. Further studies are needed to unravel the bioaccumulation mechanisms of BPA in highly polluted and nonpolluted areas.

Background & Aims: Growing evidence suggests an increased prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in the context of immune-mediated inflammatory diseases (IMIDs). We aimed to clinically and mechanistically characterize steatotic liver disease (SLD) in a prospective cohort of patients with IMID compared to controls. Methods: Cross-sectional, case-control study including a subset of patients with IMID. Controls from the general population were age-, sex-, type 2 diabetes-, and BMI-matched at a 1:2 ratio. SLD was established using controlled attenuation parameter. Liver biopsies were obtained when significant liver fibrosis was suspected. Total RNA was extracted from freshly frozen cases and analyzed by RNA-seq. Differential gene expression was performed with ‘limma-voom’. Gene set-enrichment analysis was performed using the fgsea R package with a preranked “limma t-statistic” gene list. Results: A total of 1,456 patients with IMID and 2,945 controls were included. Advanced SLD (liver stiffness measurement ≥9.7 kPa) (13.46% vs. 3.79%; p

Summary: Background: The inflammatory response in patients with traumatic brain injury (TBI) offers opportunities for stratification and intervention. Previous unselected approaches to immunomodulation in patients with TBI have not improved patient outcomes. Methods: Serum and plasma samples from two prospective, multi-centre observational studies of patients with TBI were used to discover (Collaborative European NeuroTrauma Effectiveness Research [CENTER-TBI], Europe) and validate (Transforming Research and Clinical Knowledge in Traumatic Brain Injury [TRACK-TBI] Pilot, USA) individual variations in the immune response using a multiplex panel of 30 inflammatory mediators. Mediators that were associated with unfavourable outcomes (Glasgow outcome score-extended [GOS-E] ≤ 4) were used for hierarchical clustering to identify patients with similar signatures. Findings: Two clusters were identified in both the discovery and validation cohorts, termed early-inflammatory and pauci-inflammatory. The early-inflammatory phenotype had higher concentrations of interleukin-6 (IL-6), IL-15, and monocyte chemoattractant protein 1 (MCP1). Patients with the early-inflammatory phenotype were older and more likely to have an unfavourable GOS-E at 6 months. There were no differences in the baseline injury severity scores between patients in each phenotype. A combined IL-15 and MCP1 signature identified patients with the early-inflammatory phenotype in both cohorts. Inflammatory processes mediated outcomes in older patients with moderate-severe TBI. Interpretation: Our findings offer a precision medicine approach for future clinical trials of immunomodulation in patients with TBI, by using inflammatory signatures to stratify patients. Funding: CENTER-TBI study was supported by the European Union 7th Framework Programme. TRACK-TBI is supported by the National Institute of Neurological Disorders and Stroke.

Capturing the mobility behavior of moving entities from their traces is a prominent theme in mobility data science. Stop@ supports behavior analysis by providing a generic framework for the mining of stop-move patterns in spatial trajectories across animal and human mobility scenarios. The framework is built around a stop detection method, successfully used in diverse applications in animal ecology. The method has been recently validated against accurate ground truth stops collected in a museum, proving to be effective and robust, also for the study of human mobility. Stop@ provides a rich set of functionalities to facilitate the stop-move analysis, including the parallel processing of large datasets of trajectories collected outdoor and indoor.

Resumo Objetivo analisar as potencialidades da sala de espera na Atenção Primária à Saúde para educação ambiental nas práticas de integração ensino-serviço-comunidade por meio de tecnologias educacionais. Método estudo exploratório descritivo, com abordagem qualitativa e de base documental. A coleta de dados ocorreu em dezembro de 2023, em uma instituição de ensino superior federal da região Norte do Brasil, incluindo os registros de atividade curricular obrigatória e o relatório final de monitoria, que foram submetidos à análise de conteúdo, a fim de identificar os documentos pertinentes à codificação dos quais emergiram três categorias. Resultados os dados apontaram como potencialidades: compartilhamento de informações entre usuários, profissionais e estudantes; aprimoramento de habilidades cognitivas; e promoção da saúde e sensibilização dos usuários sobre questões ambientais. O programa ofertado para qualificação do ensino, no sentido de formação para o Sistema Único de Saúde, mostrou-se uma ferramenta de impulso à educação interprofissional. Conclusões e implicações para a prática o estudo pode contribuir para a identificação de potencialidades da sala de espera no ensino e na aprendizagem sobre educação ambiental. Viabiliza estratégias de formação em saúde na perspectiva da educação, da saúde e do meio ambiente.

ABSTRACT The aim of this study was to undertake a cross-cultural adaptation of the eHealth Literacy Scale (eHEALS) instrument to measure digital health literacy of Brazilian adolescents. eHEALS is a scale consisting of 8 items that measure self-perception related to the consumption of electronic health information. This is a methodological study of cross-cultural adaptation, conducted out from February 2022 to June 2022. The following steps were carried out: a) assessment and adequacy of cultural equivalence by a committee of experts; b) back-translation; c) synthesis of back-translations; d) cognitive testing with 42 Brazilian adolescents, using cognitive interviews with probing questions. All items that were difficult to understand were adapted to the (language) context of Brazilian adolescents. Cronbach’s alpha coefficient for eHEALS-BrA was 0.81 and, if one of the items were excluded from the instrument, it ranged from 0.75-0.81. This version of the eHEALS proved to be culturally well-adapted to the context of Brazilian adolescents, and has the potential to measure digital health literacy in this population after having its validation confirmed through psychometric analyses.

A implementação da Educação para a Sustentabilidade é estratégica, já que ela possibilita que alunos tenham uma visão ampliada da realidade, percebendo os problemas do planeta, suas interconectividades e vislumbrando possíveis soluções, sendo necessário que os professores sejam formados nessa perspectiva. Assim, o objetivo deste estudo foi discutir sobre a compreensão que docentes da educação básica possuem sobre Educação para a Sustentabilidade e desenvolvimento sustentável, bem como sobre o uso que fazem de matérias didáticos livres sobre estes assuntos em suas aulas. A pesquisa qualitativa fez uso de questionários aplicados com docentes. Verificou-se que os professores trabalham conceitos e princípios inerentes a Educação para a Sustentabilidade de forma fragmentada e até desconhecem o próprio termo em si. Também não são estimulados a se articularem para buscar materiais públicos que foram produzidos, nos últimos anos, alinhados à política das agendas ambientais (a exemplo da Agenda 2030) e aos princípios da sustentabilidade, bem como esses materiais também não são devidamente divulgados nas escolas em que trabalham. Isso denota o quanto a discussão sobre sustentabilidade ainda é frágil no campo educacional, sendo recomendadas medidas urgentes para reversão desse fato.

Introducción: el trasplante de médula ósea (TMO) provoca un estado hipermeta- bólico como consecuencia del tratamien- to previo al mismo, de modo que aumenta los requerimientos nutricionales. Objetivo: evaluar el estado nutricional mediante la valoración global subjetiva ge- nerada por el paciente (VGS-GP) sometido a TMO, al ingreso y egreso hospitalario. Métodos: estudio longitudinal en 43 pa- cientes mayores de 18 años entre mayo de 2021 y junio de 2022. Se utilizó VGS-GP al in- greso y egreso hospitalario, antropometría y dinamometría, sintomatología gastroin- testinal y uso de soporte nutricional. Para la asociación entre el diagnóstico nutricional y las variables se utilizó la prueba de chi cuadrado (χ2), Fisher y la prueba de U de Mann-Whitney. También se usaron la prue- ba de Friedman y la correlación de Pearson (r) para evaluar la diferencia de las VGS-GP en ambos momentos con las variables. Resultados: un 86,05 % de pacientes estaba normonutrido al ingreso hospitala- rio y descendió a un 51,16 % al egreso, con una asociación significativa (p = 0,0147) entre ambos momentos. No se encontró una correlación estadísticamente sig- nificativa entre la circunferencia media muscular del brazo (CMMB) y la VGS-GP al ingreso (p = 0,5487), al igual que para la dinamometría manual derecha e izquierda (p = 0,5894 y p = 0,3494, respectivamente). La mucositis fue el síntoma predominante en un 66,67 %. No fue posible valorar la antropometría y la dinamometría manual al egreso hospitalario. Conclusión: la mayor parte de los pa- cientes se encontraron bien nutridos al in- greso hospitalario, mientras que al egreso dicho valor descendió a la mitad.

Resumo O objetivo da pesquisa foi verificar o conhecimento em cuidados paliativos entre estudantes de medicina de três instituições do norte de Minas Gerais. Trata-se de estudo transversal e descritivo, realizado com 320 estudantes do 1º, 6º e 11º períodos, no qual se utilizou um instrumento de pesquisa sobre filosofia, dor, dispneia, problemas psiquiátricos, problemas gástricos e comunicação. Avaliaram-se os resultados pela média das porcentagens de acerto, sendo insatisfatório o acerto de até 50%, aceitável entre 51% e 70%, desejável entre 71% e 80%, e excelente acima de 80%. Observou-se aumento de acertos com o avanço dos períodos, mas com médias insatisfatórias ou aceitáveis. Apesar dos estudantes do 11º período terem obtido toda a carga teórica do curso, suas médias de acerto não foram adequadas. Esses resultados evidenciam a necessidade de implementar na graduação em medicina o disposto na Resolução CNE/CES 3/2022, do Conselho Nacional de Educação, a fim de fomentar condutas assertivas relacionadas aos cuidados paliativos.

Background Gongolaria barbata is a canopy-forming brown macroalga that thrives in the intertidal and subtidal habitats of the warm-temperate Mediterranean Sea, which is particularly exposed to environmental changes due to its peculiar geographical location and exposure to both global and local stressors. Testing whether this species is featured by specific functional, eco-physiological and biochemical traits allowing an efficient use of habitat resources and adaptation to environmental stress, and whether this potential might change with population growth, is essential for predicting the performance of the algae under different environmental abiotic variables (e.g., temperature, nutrient availability, light) and biotic interactions (such as grazing). Methods Young (juveniles) and adult thalli of G. barbata were sampled in the winter season from the Venice Lagoon, Italy, featured by high environmental changes (temperature, salinity) and analyzed for thallus dry matter content (TDMC), photosynthetic activity, photosynthetic pigment and protein content, and antioxidant capacity to assess if thallus age may be considered a significant driver in determining the ecological responses of this species to environmental changes. Results Our results showed that TDMC was higher in adults than juveniles. At the functional level, rapid light curves indicated an elevated photosynthetic efficiency in juveniles compared to adults highlighted by the higher quantum yield of PSII electron transport, electron transport rate, and Rubisco content observed in juveniles. On the contrary, adults exhibited a higher non-photochemical quenching and total pigment concentration. No difference in maximum PSII photochemical efficiency and D1 protein content between the two thalli groups was found. Along with better photosynthesis, juveniles also displayed a higher amount of total polyphenols, flavonoids, and tannins, and a stronger antioxidant capacity compared to adults. Conclusions Our findings revealed significant differences in the eco-physiological characteristics of G. barbata at different growth stages. It was observed that young thalli, allocate more energy to photosynthesis and chemical defenses by increasing the production of antioxidant compounds, such as polyphenols, flavonoids, and tannins. With growth, thalli likely adopt a more conservative strategy, reducing photosynthesis and promoting structural biomass accumulation to mitigate the potential risks associated with prolonged exposure to environmental stressors, such as the wavy way. Although our study focused on a single phase of G. barbata life cycle under winter settings, it offers preliminary insights into this species eco-physiological traits and auto-ecology. Future research could explore the potential implications of these findings, evaluating the species’ resilience to environmental changes at the population level.

Introduction: Mental health (MH) conditions are among the most common chronic health conditions in the United States. Previous studies suggested decreased in life satisfaction post-COVID-19 in other populations outside the United States. This study explored the correlations between life satisfaction and MH among diverse community post-COVID-19 pandemic. Methods: A cross-sectional, non-experimental, retrospective study. The primary outcome was the Satisfaction with Life Scale total score (SWLS_TS) and the characteristics of the cases from self-reported information. Statistical software SPSS was used for descriptive and inferential analyses. Results: About 218 cases were included for analysis. Many of the cases were Asian Americans (n = 185, 84.1%). The multiple linear regression model significantly predicted 5.2% of the variance in SWLS_TS. Three out of 6 predictors significantly contributed to the model (age β = .172, t = 2.42, P = .017, ethnicity β = .148, t = 2.07, P = .039, and no history of MH β = .248, t = 3.31, P = .001). Conclusion: A diverse population was examined post-COVID-19 pandemic, and the findings suggest a positive correlation with age, ethnicity, and no history of MH with SWLS_TS.

Summary: Background: Traumatic brain injury is conventionally categorised as mild, moderate, or severe on the Glasgow Coma Scale (GCS). Recently developed biomarkers can provide more objective and nuanced measures of the extent of brain injury. Methods: Exposure–response relationships were investigated in 2479 patients aged ≥16 enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. Neurofilament protein-light (NFL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) were assayed from serum sampled in the first 24 h; concentrations were divided into quintiles within GCS severity groups. Relationships with the Glasgow Outcome Scale-Extended were examined using modified Poisson regression including age, sex, major extracranial injury, time to sample, and log biomarker concentration as covariates. Findings: Within severity groups there were associations between biomarkers and outcomes after adjustment for covariates: GCS 13–15 and negative CT imaging (relative risks [RRs] from 1.28 to 3.72), GCS 13–15 and positive CT (1.21–2.81), GCS 9–12 (1.16–2.02), GCS 3–8 (1.09–1.94). RRs were associated with clinically important differences in expectations of prognosis. In patients with GCS 3 (RRs 1.51–1.80) percentages of unfavourable outcome were 37–51% in the lowest quintiles of biomarker levels and reached 90–94% in the highest quintiles. Similarly, for GCS 15 (RRs 1.83–3.79), the percentages were 2–4% and 19–28% in the lowest and highest biomarker quintiles, respectively. Interpretation: Conventional TBI severity classification is inadequate and underestimates heterogeneity of brain injury and associated outcomes. The adoption of circulating biomarkers can add to clinical assessment of injury severity. Funding: European Union 7th Framework program (EC grant 602150), Hannelore Kohl Stiftung, One Mind, Integra LifeSciences, Neuro-Trauma Sciences, NIHR Rosetrees Trust.

Background: A risk haplotype in SLC16A11 characterized by alterations in fatty acid metabolism emerged as a genetic risk factor associated with increased susceptibility to type 2 diabetes (T2D) in Mexican population. Its role on treatment responses is not well understood. Objectives: We aimed to determine the impact of the risk haplotype on the metabolomic profile during a lifestyle intervention (LSI). Methods: We recruited Mexican-mestizo individuals with ≥1 prediabetes criteria according to the American Diabetes Association with a body mass index between 25 and 45 kg/m2. We conducted a 24-wk quasiexperimental LSI study for diabetes prevention. Here, we compared longitudinal plasma liquid chromatography/mass spectrometry metabolomic changes between carriers and noncarriers. We analyzed the association of risk haplotype with metabolites leveraging repeated assessments using multivariable-adjusted linear mixed models. Results: Before the intervention, carriers (N = 21) showed higher concentrations of hippurate, C16 carnitine, glycine, and cinnamoylglycine. After 24 wk of LSI, carriers exhibited a deleterious metabolomic profile. This profile was characterized by increased concentrations of hippurate, cinnamoglycine, xanthosine, N-acetylputrescine, L-acetylcarnitine, ceramide (d18:1/24:1), and decreased concentrations of citrulline and phosphatidylethanolamine. These metabolites were associated with higher concentrations of total cholesterol, triglycerides, and low density lipoprotein cholesterol. The effect of LSI on the risk haplotype was notably more pronounced in its impact on 2 metabolites: methylmalonylcarnitine (β: −0.56; P-interaction = 0.014) and betaine (β: −0.64; P-interaction = 0.017). Interestingly, lower consumption across visits of polyunsaturated (β: −0.038; P = 0.017) fatty acids were associated with higher concentrations of methylmalonylcarnitine. Covariates for adjustment across models included age, sex, genetic ancestry principal components, and body mass index. Conclusions: Our study highlights the persistence of deleterious metabolomic patterns associated with the risk haplotype before and during a 24-wk LSI. We also emphasize the potential regulatory role of polyunsaturated fatty acids on methylmalonylcarnitine concentrations suggesting a route for improving interventions for individuals with high-genetic risk.

Background Despite evidence showing that the intranasal and sublingual routes are safe and effective in providing analgesia, no data are available about their day-to-day use in the emergency department (ED). The aim of this study was to assess the frequency of the use of the intranasal and sublingual routes, and the clinical characteristics of the patients receiving analgesia through these routes.Methods A multicentre study was performed in the EDs participating in the Pain in Paediatric Emergency Room research group. It included a survey and a retrospective data collection in which the medical records of all patients who received analgesia from 1 April 2022 to 31 May 2022 were collected.Results 48 centres (91%) answered the survey. The intranasal and sublingual routes were used in 25 centres (52%). 13 centres (27%) used both routes, 9 centres (19%) used only the sublingual and 3 centres (6%) used only the intranasal route.12 centres (48%) participated in the retrospective study. Data about 3409 patients, median age 9 years (IQR 5–12), were collected. Among them, 337 patients (9.6%) received sublingual analgesia, and 87 patients (2.5%) received intranasal analgesia. The intranasal route was employed for injuries in 79 (90.8%) cases, and fentanyl was the drug delivered in 85 (97.7%) cases. The sublingual route was used mainly for injuries (57.3%), but also for abdominal pain (15.4%), musculoskeletal pain (14.5%) and headache (10.7%). Paracetamol, ketorolac and tramadol were administered through this route.Conclusions The use of the intranasal and sublingual routes for analgesia in the paediatric ED is still limited.

BackgroundThe influence of atrial fibrillation (AF) and blood pressure (BP) on brain lesions and cognitive function is unclear. We aimed to investigate the association of BP with different types of brain lesions and cognitive decline in patients with AF.MethodsOverall, 1,213 AF patients underwent standardized brain magnetic resonance imaging at baseline and after 2 years, as well as yearly neurocognitive testing. BP was measured at baseline and categorized according to guidelines. New lesions were defined as new or enlarged brain lesions after 2 years. We defined cognitive decline using three different neurocognitive tests. Logistic and Cox regression analyses were performed to examine the associations of BP with new brain lesions and cognitive decline.ResultsThe mean age was 71 ± 8.4 years, 74% were male and mean BP was 135 ± 18/79 ± 12 mmHg. New ischemic lesions and white matter lesions were found in 5.4% and 18.4%, respectively. After multivariable adjustment, BP was not associated with the presence of new brain lesions after 2 years. There was no association between BP and cognitive decline over a median follow-up of 6 years when using the Montreal Cognitive Assessment or Digit Symbol Substitution Test. However, BP categories were inversely associated with cognitive decline using the Semantic Fluency Test, with the strongest association in patients with hypertension grade 1 [Hazard Ratio (95% Confidence Interval) 0.57(0.42 to 0.77)], compared to patients with optimal BP (p for linear trend: 0.025).ConclusionsIn a large cohort of AF patients, there was no association between BP and incidence of brain lesions after 2 years. Also, there was no consistent association between BP and cognitive decline over a follow-up of 6 years. Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT02105844, Identifier (NCT02105844).

Objective: The objective of this study was to evaluate whether long stays in non-European countries influence the composition, diversity, and dynamics of gut microbiota, considering the potential impact of travelling, close contact with new people, and consumption of water and food. Methods: Two prospective cohorts were analyzed: (i) A longitudinal cohort comprising long-term travellers who provided fecal samples before and after their travels. (ii) A cohort consisting of long-term travellers and recently arrived migrants from non-European countries, which was compared with non-traveller controls. Each participant self-collected fecal samples and provided demographic and epidemiological data. Microbiota was characterized through 16 S rRNA gene sequencing. Results: The longitudinal cohort comprised 17 subjects. A trend toward higher bacterial diversity was observed after travelling (Shannon index 3.12vs3.26). When comparing 84 travellers/migrants with 97 non-travellers, a confirmed association of higher diversity levels with travelling was observed (Phylogenetic diversity: 22.1vs20.9). Specific genera enriched in travellers' gut microbiota were identified, including Escherichia/Shigella, Bacteroides, and Parabacteroides. The analysis revealed three major clusters with profound differences in their bacterial composition, which exhibited differential distribution between travellers and non-travellers (Adonis P