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Though Health Technology Assessment (HTA) has steadily grown over the past decades, less attention has been paid to the way HTA may prove more responsive to the broader economic, social, and environmental challenges that health systems are facing today. In view of climate change, chronic diseases, an aging population, inequalities, and workforce issues, the HTA community’s unique set of skills nonetheless holds great potential to help decision-makers strengthen many publicly funded health systems around the world.
Methods
This article adopts an integrated system-wide perspective guided by the Responsible Innovation in Health (RIH) framework to explore how the HTA community may not only adapt to the speed of innovation but also consider its direction.
Results
Because RIH aims to steer innovation toward a more sustainable pathway, it can help HTA agencies anticipate decision-makers’ informational needs regarding four systemic challenges: (1) equitable access; (2) workforce issues; (3) accountable policy trade-offs; and (4) environmental sustainability. We clarify how key elements of the RIH framework may be used by HTA agencies to: (1) supplement their evaluation process; (2) align their priority-setting or strategic planning activities with their health system challenges; or (3) inform the production of early HTAs, horizon scans, or reports that are broader in scope than a single technology review.
Conclusions
The article concludes with three practical implications that were identified by the Institut National d’Excellence en Santé et Services Sociaux (INESSS) (Québec, Canada) and may inspire other HTA agencies.
This study evaluated the effects of capsaicin (CAP) supplementation on the intake, nutrient digestibility, ruminal fermentation, nitrogen balance, microbial protein synthesis and health traits of bulls managed on pasture. Eight crossbred (Holstein x Zebu) cattle averaging 313 ± 31 kg of body weight (BW) were arranged in a replicated 4 × 4 Latin square design (one square of four bulls, rumen fistulated with 4-inch silicone cannulas and one square of four non-fistulated bulls), which were kept on Pangola grass pasture (Digitaria decumbens). Each experimental period consisted of 21 days, with 7 days for data collection (no washout between periods). Bulls were randomly assigned to the following treatments: CON (control): concentrate supplementation at 0.5% live weight (BW) and no additive (CAPCIN®), or concentrate supplementation at 0.5% BW in association with CAPCIN® (NutriQuest, Campinas, Brazil) fed at the inclusion rates of 150 (CAP150), 300 (CAP300) and 450 (CAP450) mg/animal/day. Digestibilities of dry matter, organic matter and neutral detergent fibre showed quadratic responses to CAP supplementation. Rumen pH linearly increased with CAP supplementation. The numbers of lymphocytes and eosinophils were linearly increased with CAP supplementation. The use of encapsulated pepper in supplements of crossbred (Holstein x Zebu) bulls managed on D. decumbens pasture up to 450 mg/animal/day improves nutrients digestibility and ruminal fermentation and can positively influence the health status of beef cattle managed under tropical conditions.
Visceral leishmaniasis (VL) is a tropical disease that can be fatal if acute and untreated. Diagnosis is difficult, the treatment is toxic and prophylactic vaccines do not exist. Leishmania parasites express hundreds of proteins and several of them are relevant for the host's immune system. In this context, in the present study, 10 specific T-cell epitopes from 5 parasite proteins, which were identified by antibodies in VL patients’ sera, were selected and used to construct a gene codifying the new chimeric protein called rCHI. The rCHI vaccine was developed and thoroughly evaluated for its potential effectiveness against Leishmania infantum infection. We used monophosphoryl lipid A (MPLA) and polymeric micelles (Mic) as adjuvant and/or delivery system. The results demonstrated that both rCHI/MPLA and rCHI/Mic significantly stimulate an antileishmanial Th1-type cellular response, with higher production of IFN-γ, TNF-α, IL-12 and nitrite in vaccinated animals, and this response was sustained after challenge. In addition, these mice significantly reduced the parasitism in internal organs and increased the production of IgG2a isotype antibodies. In vivo and in vitro toxicity showed that rCHI is safe for the mammalians, and the recombinant protein also induced in vitro lymphoproliferative response and production of Th1-type cytokines by human cells, which were collected from healthy subjects and treated VL patients. These data suggest rCHI plus MPLA or micelles could be considered as a vaccine candidate against VL.
Introduction: Throughout the course of the dementia, patients generally need a guardian to protect their rights due to the severity of their mental disabilities. The laws and procedures for guardianship for people with disabilities have been updated in several countries based on the UN Convention on the Rights of Persons with Disabilities promulgated in 2006.
Objectives: To compare the law and procedures for guardianship for people with mental disabilities of twelve countries from six continents.
Methods: Narrative review searching for civil codes/guardianship procedures, date of promulgation, scope of the guardian authority, preferred guardian, duration of the guardianship.
Results: Most countries predominantly promulgated their laws after the year 2000, being half of them updated after 2006. Most countries have two types of guardianship scopes: one concerning financial affairs and the other concerning personal affairs (such as welfare and medical care). Generally, guardianship concerning financial matters is the first to be established. In addition, most countries maintain the ward’s right to vote. In five out of twelve countries, there is an order of preference for choosing the guardian, being the spouses and adult children the preferred guardians. All these countries have the possibility of temporary guardianship. Three countries have a maximum period for guardianship with the possibility of renewal, while all others have indefinite time for guardianship duration. Only France explicitly grants the right to the ward to make medical decisions within guardianship procedures. Brazil’s Civil Code restricts guardianship to financial matters, whereas the Civil Procedure Code requires judges to define the scope of guardianship’s authority for each of the activities of the civil life. Since both codes hold equal authority, judges typically determine the extent of guardianship on a case- by-case basis.
Conclusions: Half of the nations have updated their laws after the promulgation of the UN Convention on the Rights of Persons with Disabilities.
Dementia is expected to increase worldwide and further Discussion concerning the rights of people with dementia is still needed. Although there is no ideal legal framework, the comparison of procedures from different countries may lead to valuable insights for further Discussions andassessments.
Alcohol and illicit drug use are highly prevalent among the homeless population. Religiosity and spirituality (RS) have been widely associated with lower substance use. However, evidence of this relationship among the homeless is still scarce.
Objectives
To assess the association between RS and the use of alcohol and illicit drugs among the homeless population of a large Brazilian urban center.
Methods
This cross-sectional study was conducted in São Paulo, Brazil. Aspects such as spirituality (FACIT-Sp12), religiosity (P-DUREL), religious-spiritual coping (Brief-RCOPE), and self-applied questions about current substance use (alcohol and illicit drugs) were evaluated. Adjusted Logistic Regression models were performed.
Results
A total of 456 homeless individuals were included, with an average age of 44.5 (SD=12.6) years. More than half of the participants used alcohol (55.7%) weekly and 34.2% used illicit drugs weekly. The adjusted Logistic Regression models identified that aspects of RS were associated with a lower propensity for alcohol and illicit drug use, whereas negative religious-spiritual coping strategies were associated with a higher propensity for the use of both.
Conclusions
The prevalence of alcohol and illicit drug use among participants was high. Positive RS and religious-spiritual coping were significant protective factors against the use of these substances. Conversely, negative religious-spiritual coping strategies were associated with risk factors.
Individuals experiencing psychotic symptoms often lack insight into their conditions, especially in first psychotic episodes. According to the Portuguese Mental Health Law, involuntary hospitalization may be necessary in cases of severe mental disorder, involving a threat to the patient or his/her legal assets, when there is a refusal of the necessary treatment.
Objectives
The aim of our study was to characterize patients admitted involuntarily for first psychotic episode and to compare them with the patients undergoing inpatient voluntary treatment.
Methods
Out of a total of 87 patients diagnosed with first psychotic episode, hospitalized between 2020 and 2022 in our service, at Hospital Magalhães Lemos, 65 were included in the study. Exclusion criteria included patients from other residential areas. 40 patients were admitted under involuntary treatment, whereas 25 were hospitalized voluntarily. For both groups, we calculated the duration of untreated psychosis, the prevalence of psychoactive substance abuse, the type of treatment provided and the number of re-hospitalizations.
Results
Patients in involuntary treatment had longer duration of untreated psychosis (71 vs 38 weeks). Among these patients, 53% had comorbid psychoactive substance abuse, in contrast with only 36% of voluntarily treated patients. Upon discharge, 58% of patients in involuntary treatment were prescribed depot antipsychotic medication, whereas only 12% of the ones in voluntary treatment. Out of 40 patients admitted involuntarily, 11 were re-hospitalized, but only 4 of the 25 patients in voluntary treatment (28 vs 16%).
Conclusions
Patients in involuntary treatment probably suffered from more severe disease, as seen for the higher duration of untreated psychosis and frequent comorbid substance abuse. Injectable medication was the preferred choice at the time of discharge for this group. Additionally, they experienced higher rates of re-hospitalizations. Recent changes in Portuguese Mental Health Law, that aims to safeguard the rights and responsibilities of individuals with mental health care needs, motivated this study.
Humanistic studies applied to the health-illness clinic go beyond explaining cause-effect relationships among disease phenomena, treatments, and preventions. Qualitative research aims to understand symbolic relationships built in life experiences among the manifestations and the people. How to act in front of a person whose physical appearance and odour can be unpleasant, such as in the HNC - Head Neck Cancer? Or whose life history may have been marked by deviant behaviours and negligence in self-care?
Objectives
To interpret emotional meanings attributed through open interviews conducted with relatives about the domestic care of patients with HNC under clinical treatment.
Methods
Sample composed of family caregivers of patients with HNC, sent sequentially by colleagues from the clinical service who were informed of the research. The study used the Clinical-Qualitative Method (Turato. Portuguese Psychos. J, 2000 2(1): 93-108). Semi-Directed Interview with Open-ended Questions In-Depth and Field Notes was used for data collection. The employ of the Seven Steps of the Clinical-Qualitative Content Analysis (Faria-Schützer et al. Cien Saude Colet. 2021; 26(1): 265-274) has permitted the understanding of the topics. Sample closed with 12 persons according to the information saturation strategy (Fontanella et al. Cad Saude Publica. 2008; 24(1): 17-27), conducted by the first author, a female psychologist. To interpret the empirical material, we use Medical/Health Psychology, the psychodynamics of relationships of the Balintian framework, disease and illness while modes of un-health, psychic defence mechanisms against anguish. Validation by peers from the Lab of Clinical-Qualitative Research Laboratory, at the State University of Campinas.
Results
For this presentation, we listed three categories from the free-floating re-readings: (1) Certain need to recognize the care provided as a handling strategy with effort, putting in this ‘validation’ their relief regarding natural suffering of the care process; (2) Caregiver’s psychological fantasies of omnipotence in the care process, frequently perceiving the reality a phenomenologically and necessarily distorted by the caregiver. (3) Moments of impotence feeling in front of the finitude reality that it knows will arrive.
Conclusions
The family caregivers can present certain emotional defences, such as subtle magical thinking, in which they distort the reality experienced as a management strategy and validation of their care. They act so to alleviate their psychological and existential suffering. Group meetings with family members to talk openly about the difficulties on the psychological management of patients with HNC, coordinated by a psychotherapist, are effective as a space for creativity in daily management at home and a space for catharsis.
Different fertilization strategies can be adopted to optimize the productive components of an integrated crop–livestock systems. The current research evaluated how the application of P and K to soybean (Glycine max (L.) Merr.) or Urochloa brizantha (Hochst. ex A. Rich.) R. D. Webster cv. BRS Piatã associated with nitrogen or without nitrogen in the pasture phase affects the accumulation and chemical composition of forage and animal productivity. The treatments were distributed in randomized blocks with three replications. Four fertilization strategies were tested: (1) conventional fertilization with P and K in the crop phase (CF–N); (2) conventional fertilization with nitrogen in the pasture phase (CF + N); (3) system fertilization with P and K in the pasture phase (SF–N); (4) system fertilization with nitrogen in the pasture phase (SF + N). System fertilization increased forage accumulation from 15 710 to 20 920 kg DM ha/year compared to conventional without nitrogen. Stocking rate (3.1 vs. 2.8 AU/ha; SEM = 0.12) and gain per area (458 vs. 413 kg BW/ha; SEM = 27.9) were higher in the SF–N than CF–N, although the average daily gain was lower (0.754 vs. 0.792 kg LW/day; SEM = 0.071). N application in the pasture phase, both, conventional and system fertilization resulted in higher crude protein, stocking rate and gain per area. Applying nitrogen and relocate P and K from crop to pasture phase increase animal productivity and improve forage chemical composition in integrated crop–livestock system.
The objective was to evaluate energy partitioning and predict the relationship between metabolizable energy (ME) and digestible energy (DE) in hair sheep fed tropical diets at three feeding levels (maintenance, intermediate and high). To evaluate the energy partition, a database with 114 records (54 non-castrated males and 60 females) from comparative slaughter studies was used. To estimate the ratio ME:DE, 207 observations (74 non-castrated males and 133 females) were used from six studies in a multi-study approach, two indirect calorimetry studies (n = 93) and four comparative slaughter (n = 114), using a mixed model and study as random effect. A simple linear regression equation of the ME against DE was fitted to predict the efficiency of DE to ME conversion. Gas losses were greatest (P < 0.05) for animals fed at maintenance level (7.92% of gross energy intake). The variations of energy losses in the urine were 2.64, 2.06 and 2.08%; faecal losses were 34.37, 37.80 and 36.91% for maintenance, intermediary and high level of feeding, respectively. The regression analysis suggested a strong linear relationship between ME and DE, generating the model ME (MJ/day) = −0.1559 (±0.07525) + 0.8503 (±0.005864) × DE (MJ/day). This study highlights the importance of the relationship ME:DE. Equation/factor 0.85 presented herein is alternative that could be used for the calculation of ME from DE in feedlot diets tropical. In conclusion, we suggest that for hair sheep fed tropical diets the conversion factor 0.85 is more adequate to predict ME from DE.
Having a family member admitted in Intensive Care Unit (ICU) can cause a severe psychological stress, and various psychological disorders gathered into the notion of Post intensive care syndrome-family (PICS-F). In this way, Family-centered care in ICU represents the aim of international accepted recommendations focusing on a partnership approach to health care decision-making between the family and health care provider to prevent PICS-F. During the first SARS-CoV-2 linked lockdown, social restrictions impaired the right application of these recommendations, increasing risk of PICS-F, particularly Post-Traumatic Stress Disorder (PTSD).
Objectives
The main objective was to compare the PTSD prevalence at 6 months in a group of relatives including during OLAF implementation with a control group in a cohort of ICU-patient relatives.
Methods
Considering this, the psychiatric team and the ICU team of the Toulouse University, France, proposed the creation of a temporary device called OLAF (Opération de Liaison et d’Aide aux Familles in French), aiming to bring a psychological phone support to ICU-patient relatives. Besides this operational approach we designed a research approach that aimed to investigate the impact of OLAF device on PICS-F.
Results
We noted that 12 participants (11.5 %) presented a PTSD at 6 months without statistically significant differences between the groups (p=0.8). Considering that OLAF group presented higher PDI (Peritraumatric Distress Inventory) score at screening we also considered a mediation model suggesting that OLAF could have played a role to diminish the PCL-5 score as a covariable. In the multinomial logistic regression analysis, we found that the only factor associated with the PTSD diagnosis was the level of Anxiety and Depression Signs measured with HADS (Hospital Anxiety and Depression Scale) at screening (OR= 1.2, p<0.001).
Conclusions
We found no difference in PTSD prevalence according to OLAF intervention. Nevertheless, our result suggested that the intervention could have play a role in reducing PTSD by acting on anxiety and peri traumatic distress in a mediated model. We found that anxiety score could serve as a risk marker to predict PTSD and should probably be precociously screened and treated in this population.
Gaining competitive advantage is essential to modern organizations, for which it is fundamental that workers are engaged with their work. Perceived age discrimination in the workplace is a factor that may influence workers’ engagement.
Objectives
The present study aimed to analyze the moderating role of emotional regulation in the relationship between perceived age discrimination and work engagement.
Methods
This empirical study included a sample of 452 Portuguese workers of various age groups, between 18 and 65 years-old and used the questionnaire as data collection method.
Results
Results show that perceived workplace age discrimination negatively impacts work engagement. Further, results suggest that emotional regulation exacerbates the negative relationship between perceived age discrimination and work engagement.
Conclusions
Age management strategies to address perceived age discrimination and work engagement, particularly due to the increasing proportion of older workers, are discussed.
Preeclampsia (PE) affects up to five times more women with pre-existing diabetes mellitus (PDM) than women without it. The present study aimed to identify the effect of the DASH diet on PE incidence (primary outcome) and blood pressure, glycated haemoglobin (GH), serum lipids, glutathione peroxidase (GP), C-reactive protein (CRP – secondary outcomes) in pregnant with PDM. This randomised, controlled, single-blind trial studied sixty-eight pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital, Brazil. The standard diet group (SDG) received a diet containing 45–65 % carbohydrates, 15–20 % protein and 25–30 % lipids. The DASH diet group (DDG) received the adapted DASH diet with a similar macronutrient distribution, but with a higher concentration of fibres, unsaturated fats, calcium, magnesium and potassium as well as lower saturated fat. Student's t, Mann–Whitney U and the Chi-square tests were used to compare outcomes. PE incidence was 22⋅9 % in the SDG and 12⋅1 % in the DDG (P = 0⋅25). GP levels significantly increased in the DDG (intra-group analysis; mean difference = 1588 [CI 181, 2994], P = 0⋅03) and tended to be different from the variation in the SDG (mean difference = −29⋅5 [CI −1305; 1⋅365]; v. DDG: 1588 [CI 181; 2994], P = 0⋅09). GH levels decreased significantly and similarly between groups (SDG: −0⋅61 [CI −0⋅26, −0⋅96], P = 0⋅00) v. DDG: −1⋅1 [CI −0⋅57, −1⋅62], P = 0⋅00). There was no evidence of a difference in PE incidence at the end of the intervention between the two diets. The DASH diet seems to favour PE-related biochemical markers.
The giant African land snail, Achatina fulica, is an important invasive species in many countries, where it causes losses in biodiversity and agriculture, as well as impacting the health of both humans and animals, as the intermediate host of medically important nematodes. The present study is based on a comprehensive review of the literature on the nematodes that have been found in association with A. fulica, worldwide. We searched a number of different databases and used the findings to investigate the methods used to extract and identify the nematodes, their larval stages, and environment and collecting procedures of the infected molluscs. Between 1965 and 2021, 11 nematode species were recorded in association with A. fulica in 21 countries. Most of the studies recorded associations between A. fulica and Angiostrongylus cantonensis, which causes cerebral angiostrongyliasis in humans and Aelurostrongylus abstrusus, which provokes pneumonia in felines. The nematodes were extracted primarily by artificial digestion with hydrochloric acid or pepsin, and identified based on their morphology or through experimental infection to obtain the adult. In most cases, the nematodes were at larval stage L3, and the infected A. fulica were collected from anthropogenic environments. The results demonstrate the importance of A. fulica as a host of nematodes of medical and veterinary importance, as well the contribution of anthropogenic environments to the occurrence of the parasites, and give information about the different methods used to collect and identify the nematodes found associated with this species.
Oocyte gene expression is a well controlled event that promotes gamete competence to undergo maturation, fertilization, and to support early embryo development, directly affecting reproductive outcomes. Considering that in vivo controlled ovarian stimulation or in vitro maturation (IVM) for the acquisition of mature oocytes has distinct implications for gene expression, we sought to evaluate the effects of these procedures on the expression of competence-related genes in single-cell oocytes. Healthy Nelore cows of reproductive age were synchronized to harvest in vivo matured oocytes; ovaries from slaughtered animals were used to obtain cumulus–oocyte complexes that were in vitro matured. Single-cell gene expression was performed using TaqMan Low-Density Arrays and 42 genes were evaluated. In silico analysis of protein interactions and Gene Ontology (GO) analysis was performed. Reduced gene expression was observed for 24 targets in IVM oocytes when compared with those of in vivo matured oocytes (P < 0.05). Differences ranged from 1.5-fold to 4.8-fold higher in in vivo oocytes and the BMP15 (5.28), GDF9 (6.23), NOBOX (7.25), HSPA8 (7.85) and MSX1 (11.00) showed the greatest fold increases. The strongest score of functional interactions was observed between the CDC20 and CKS2, with the differentially expressed gene CDC20 being the main marker behind GO enrichment. IVM negatively affected the expression of important genes related to oocyte competency, and showed higher expression levels in in vivo matured oocytes. In vivo controlled ovarian stimulation may be a better strategy to achieve proper oocyte competence and increase the success of assisted reproductive technologies.
The water balance and urinary parameters of lambs fed diets containing cactus cladodes varieties were evaluated. Thirty-six uncastrated male Santa Inês lambs (22.0 ± 2.9 kg initial body weight) were distributed in a completely randomized design, with three treatments and 12 replicates. The animals were fed a control diet (Tifton-85 hay as exclusive roughage), Miúda or Orelha de Elefante Mexicana (OEM) cactus-based diets. Urine samples were collected 45 days after the introduction of the tested diets, and voluntary water intake was measured over 10 days, during the experimental period. Diets containing Miúda or OEM cactus caused a reduction of 68.35 and 77.03% in voluntary water intake, respectively. In addition, the Miúda cactus cladodes caused urinary alkalinization (pH = 8.14) and reduction in the urinary excretion index (UEI) and on the fractional excretion rate (FER) of total calcium (Ca). The diets with OEM cactus cladodes caused higher oxalates intake (6.21 g/day) and increase in urinary volume. Regardless of the variety, there was a reduction in the urinary concentrations of urea, creatinine, total proteins, Ca, phosphorus (P), UEI of urea and P, as well as in FER of P, compared to the control diet. Urinary Mg content and UEI of uric acid and Mg increased and FER of P decreased by diets supplemented with different varieties of cactus cladodes. In conclusion, the cactus cladodes increased water intake and retention, and diuresis in lambs, altered urine parameters, without compromising kidney function.
The home-field advantage (HFA) hypothesis establishes that plant litter decomposes faster at ‘home’ sites than in ‘away’ sites due to more specialized decomposers acting at home sites. This hypothesis has predominantly been tested through ‘yes or no’ transplanting experiments, where the litter decomposition of a focal species is quantified near and away from their conspecifics. Herein, we evaluated the occurrence and magnitude of home-field effects on the leaf litter decomposition of Myrcia ramuliflora (O.Berg) N. Silveira (Myrtaceae) along a natural gradient of conspecific litterfall input and also if home-field effects are affected by litter and soil traits. Litter decomposition of M. ramuliflora was assessed through litterbags placed in 39 plots in a tropical heath vegetation over a period of 12 months. We also characterized abiotic factors, litter layer traits, and litter diversity. Our results indicated the occurrence of positive (i.e. Home-field advantage) and negative (i.e. Home-field disadvantage) effects in more than half of the plots. Positive and negative effects occurred in a similar frequency and magnitude. Among all predictors tested, only the community weighted mean C/N ratio of the litterfall input was associated with home-field effects. Our results reinforce the lack of generality for home-field effects found in the literature and thus challenge the understanding of litter-decomposer interaction in tropical ecosystems.
Fusarium head blight (FHB) and stem rust (SR) threaten the sustainability of wheat production worldwide. Fhb1 and Sr2 confer partial durable resistance to FHB and SR, respectively. Despite resistant alleles of both genes are linked in repulsion, lines with Fhb1-Sr2 in coupling were developed at the University of Minnesota, USA. Marker-assisted backcrossing was used to incorporate the coupled Fhb1-Sr2 into four elite INIA-Uruguay spring wheat varieties lacking both genes and expressing different levels of FHB and SR resistance. In each case, the initial cross between the donor line and recurrent parent was backcrossed three times. Genotypes carrying Fhb1-Sr2 were selected using the molecular marker UMN10. In BC3F3 families, retention of Fhb1-Sr2 was further confirmed with the markers SNP3BS-8 and Sr2-ger9 for Fhb1 and Sr2, respectively. BC3F3 homozygous lines contrasting at UMN10, SNP3BS-8 and Sr2-ger9 were obtained to quantify the effect of Fhb1-Sr2 on the resistance to FHB under controlled conditions and to SR under field conditions. After 26 months period, successful introgression of Fhb1-Sr2 into the four cultivars was achieved, representing novel wheat genetic resources. Lines homozygous for the resistant alleles of Fhb1 were significantly more resistant to FHB as reflected by an 18% reduction of average FHB area under the disease progress curve. A significant effect of Sr2 on SR field resistance was observed in lines derived from the most susceptible cultivar ‘Génesis 2375’. The most resistant lines to both diseases are expected to be valuable genetic resources in breeding for durable resistance to FHB and SR.