Objectives: Patient centred care is an increasingly important paradigm. Applying a treat-to-target strategy to the impact of the disease in patients' lives seems a very promising tool to serve this purpose. We aimed to evaluate if maximum acceptable impact scores (target-values) defined at the population level provide an appropriate representation for most individual patients. To determine if the individually established target values of impact are consistent enough to be used in a treat-to-target strategy. Methods: Consecutive patients with rheumatoid arthritis were asked to indicate, in two consecutive visits, the maximum severity of impact they considered acceptable to live with for the rest of their lives, in the seven domains of Rheumatoid Arthritis Impact of Disease score. The individual adequacy of population-based reference values was assessed by measures of dispersion. Stability of individual target-values were evaluated through intraclass correlation coefficient. Socio-demographic, clinical and psychological features were tested as co-factors of stability. Results: 299 patients were included. The dispersion of targets was wide (CV>0.68), thus limiting the use of any population-based single values as targets for the individual patients. Although the mean target values were very similar in both visits for all domains, reliability was poor in all cases (ICCs: 0.37-0.47). Only 25-30% of the patients selected the same target value in the 2 visits. No explanatory factors for (non-)stability were identified. Conclusions: Quantified impact targets defined at population level are not appropriate for individual patient care. Research on alternative tools to support patient-centred, target-oriented management strategies is warranted.
The COVID-19 has caused not just an unprecedented sanitary crisis but a social crisis, which has affected, among many other fields, the local journalism, which had to adapt to meet the public’s information needs about coronavirus. In this study we analyzed the evolution of local news about COVID-19 in Spain throughout the pandemic by examining local news articles in social media. Using a unique dataset of over 230k Facebook posts published by Spanish local media organizations during 2020 and 2021, we found evidence that the interest of local media in COVID-19, measured as the proportion of the news related to COVID-19, changed as the pandemic evolved. Our results also show that the interest that local media readers had in COVID-19, measured as the proportion Facebook interactions related to COVID-19, was even higher, and also evolved during the pandemic. Although the interest in COVID-19 of local media and their readers essentially progressed in parallel, we also identified some periods in which they behaved differently. While a fatigue with COVID-19 related news would be expected after 2 years of pandemic, a clear decrease of interest was not observed neither in journalists nor in readers.
Rickettsiosis is considered an emerging/re-emerging vector-borne disease that causes significant public health threats. Ticks are reservoirs and vectors of Rickettsia having a significant role in the transmission of rickettsiae. In Portugal, little is known about tick-borne Rickettsia species in sheep. Therefore, this study aimed to investigate rickettsiae infection in ticks and their sheep host from 27 farms in four districts of central Portugal, to clarify the role of the sheep host in the circulation of this zoonotic agent. Between March and May 2021, EDTA blood samples (n = 100) of healthy grazing sheep and their ticks (n = 100, one tick per animal) were collected during a herd health program in central Portugal. Obtained ticks were identified as Rhipicephalus sanguineus sensu lato by PCR targeting a partial sequence of 16S rRNA gene followed by sequence analysis. Rhipicephalus sanguineus s.l. and host sheep blood were tested for the presence of Rickettsia spp. by PCR targeting a partial sequence of ompB and ompA genes. From a total of 100 paired R. sanguineus s.l. and host sheep, Rickettsia massiliae was detected in 62 ticks and 35 grazing sheep blood samples, collected in central Portugal, 2021. All 35 positive sheep had attached positive R. sanguineus s.l., with matching nucleotidic sequences. These findings suggest that sheep may develop rickettsiemia and are likely capable of transmitting and amplifying the infection to uninfected ticks maintaining rickettsiae in circulation in the domestic cycle.
Crimean-Congo hemorrhagic fever virus (CCHFV) is a widespread zoonotic pathogen that can cause mild to severe hemorrhagic disease in humans. CCHFV may be transmitted through direct contact with tissue or blood of viremic animals; however, the primary transmission route is through infected tick bites. CCHFV RNA has been detected in ticks feeding on domestic and wild animals in western Spain, suggesting an established circulation of CCHFV in Western Europe. Ruminants have been recognized as important CCHFV reservoirs and have been linked to human cases in endemic regions. Given the emergence of CCHF in neighboring Spain, and a report of two CCHFV seropositive humans in southern Portugal in 1985, we investigated the potential circulation of this virus in the country by performing a nationwide anti-CCHFV IgG serosurvey in sentinel sheep of Portugal. Sera (n = 459) randomly selected from widely distributed farms (n = 20) of Portugal were tested using a commercial double-antigen enzyme-linked immunosorbent assay, yielding an overall seroprevalence of 0.4% (95% confidence interval [CI] 0.04–1.56%). Positive sheep were from the southern region of Portugal (Alentejo region), which raise the seroprevalence of this region to 0.74% (95% CI 0.09–2.66%). This is the first study reporting the presence of CCHFV antibodies in sheep of Portugal, thus suggesting a geographical expansion of CCHFV to this country. It seems likely that CCHFV may exist focally in southern Portugal.
Introdução: O transporte inter-hospitalar do doente crítico é um dos momentos assistenciais mais delicados, durante o qual é necessário manter o suporte das funções vitais, que se inicia com a preparação do mesmo até ao momento em que o doente chega ao destino final. Objetivo: Identificar o papel do enfermeiro e mapear as intervenções autónomas e/ou interdependentes executadas pelos enfermeiros no transporte inter-hospitalar do doente crítico. Identificar a formação específica que os enfermeiros possuem, que os habilita a efetuar os transportes inter-hospitalares. Métodos: Esta Revisão Scoping seguiu a metodologia do Joanna Briggs Institute e pretendeu listar estudos publicados e não publicados sobre transporte inter-hospitalar de doentes em estado crítico, a partir de 2001 em inglês, português, francês e espanhol. A análise dos estudos foi realizada por dois revisores independentes. Resultados: Os resultados foram agrupados e exploram os seguintes dados: autor; ano de publicação; país; objetivos dos estudos; métodos; população estudada; formação e competências dos enfermeiros; intervenções administradas e resultados. Conclusão: O papel do enfermeiro no transporte inter-hospitalar do doente crítico vai para além da aplicação de técnicas de enfermagem, a sua maior contribuição prende-se com a gestão de todo o processo clínico, aplicando os seus conhecimentos técnicos, mas também as competências pessoais que são de extrema importância para garantir o cuidado e o bem-estar do doente.
Objective: to understand higher education students' perceptions of sexual and reproductive health risk behaviours. Methods: a descriptive study following a qualitative approach was conducted, using Pender's Health Promotion Model as a theoretical and methodological framework. A thematic analysis of the data obtained from different focus groups was performed. Results: participants consider that factors such as communication with their sexual partner, the ability to negotiate and a positive attitude regarding condoms are positive aspects that will encourage consistent use of condom. The embarrassment felt at the time of purchase, the reduction of sexual pleasure and the growing stability of the relationship are usually seen as barriers. Final considerations: the study was crucial to identify some strategies that will be considered in further health promotion programmes, namely peer education, and will help promote personal and social skills and the (re)organisation of healthcare services.
This paper presents a multi-objective algorithm to support sizing and placement of Renewable Distributed Generation with storage units (RDG&S) in radial distribution networks. Two objectives are considered in the model, the first one is focused in the minimization of the RDG&S units capital costs and the second one in the minimization of system losses. This approach uses a hybrid Ant Colony Genetic Algorithm (ACGA) divided in two steps. At the first step of the approach an Ant Colony (AC) acts to face with the uncertainty of the problem and to deal with instabilities of the initial data. This way a good Pareto front, which is used to feed the initial population of da Genetic Algorithm (GA). At the second step, an Elitist Robust Genetic Algorithm with a secondary population is used, to characterize the non-dominated Pareto Optimal Frontier. In this algorithm the concept of robustness is operationalized in the computation of the fitness value assigned to solutions. The results presented in this approach demonstrates the real capabilities of the proposed algorithm to generate a well-spread and more robust effective non-dominated Pareto Optimal Frontier.
Dynamic capabilities (DCs) are a growing field of research within the scope of theoretical structures based on resource and strategic management. Given the demonstrated impact of DCs on company performance, it is important to study the effects of DCs on small and medium sized enterprises (SMEs) within the context of the COVID-19 pandemic. Hence, this research evaluates the role of DCs during the pandemic and its impact on the performance levels of SMEs. Analysing the responses of 209 SMEs using a structural equations model, we report that DCs positively affect company performance both prior to and during the pandemic. However, we also verify that while prior to the pandemic companies placed greater emphasis on the search for new opportunities, following the onset of the pandemic the focus shifted to getting their products to the market. These results contribute to the literature on strategic management and the DC based approach during periods of turbulence and pandemics.
The close contact between humans and domestic cats raises concerns about the potential risks of SARS-CoV-2 transmission. Thus, this study aims to investigate anti-SARS-CoV-2 IgG seroprevalence in client-owned cats from Portugal and evaluate the infection risk of cats that maintain contact with human COVID-19 cases. A total of 176 cats, belonging to 94 households, were sampled. Cat owners answered an online questionnaire, and cats were screened for antibodies against SARS-CoV-2 using a commercial ELISA. Twenty (21.3%) households reported at least one confirmed human COVID-19 case. Forty cats (22.7%) belonged to a COVID-19-positive and 136 (77.3%) to a COVID-19-negative household. The seroprevalences of cats from COVID-19-positive and -negative households were 5.0% (2/40) and 0.7% (1/136). The two SARS-CoV-2-seropositive cats from COVID-19-positive households had an indoor lifestyle, and their owners stated that they maintained a close and frequent contact with them, even after being diagnosed with COVID-19, pointing towards human-to-cat transmission. The SARS-CoV-2-seropositive cat from the COVID-19-negative household had a mixed indoor/outdoor lifestyle and chronic diseases. Owners of the three SARS-CoV-2-seropositive cats did not notice clinical signs or behavior changes. This study highlights the low risk of SARS-CoV-2 transmission from COVID-19-positive human household members to domestic cats, even in a context of close and frequent human–animal contact.
Introduction In an increasingly multicultural world, when interacting with immigrant women, the obstetric nurse seeks to develop intercultural mediation strategies for a culturally competent care Goals To understand the meaning attributed by obstetric nurses to intercultural mediation practices during interaction with migrant pregnant women; Methods Qualitative study, using the phenomenological-hermeneutic method, with phenomenological interviews as data collection instrument. Ten nurses working in the delivery room of a hospital in Greater Lisbon agreed to participate in the study. Qualitative data analysis was used, supported by Nvivo12. This study is part of the project Intercultural Mediators in Health Care Units - MEIOS - Intercultural Mediation and Health Outcomes, developed by the Higher Education Network in Intercultural Mediation, promoted by the High Commission for Migrations, authorized by the CNPD and the Ethics Committee of the Institution where the study was conducted; Results Three categories emerged: Strategies used by the obstetric nurse to become an intercultural mediator" with emphasis on: consolidate cultural knowledge; the category Practices of the intercultural mediator as perceived by obstetric nurses with emphasis on: building bridges between professionals and immigrant women, enabling the obstetric nurse to provide better care, knowing the immigrant woman's culture, enabling the obstetric nurse to understand the immigrant woman's needs, and helping immigrant women to understand the care provided; and, finally, the category Difficulties recognized by the obstetric nurse to become an intercultural mediator with emphasis on the lack of training in relation to cultural diversity and immigration Conclusions. Nurses recognize the importance of the functions of an intercultural mediator in the maternity ward. However, they encounter difficulties in establishing the interaction, which leads them to adopt intercultural mediation strategies to promote culturally congruent care, and better understanding of the immigrant women's needs which will be reflected in higher quality of care, health and well-being.
The treatment of animal slurry is used to improve management on a farm scale. The aim of this laboratory study was to assess the effects of the addition of the additives biochar, alum and clinoptilolite before the mechanical separation of whole pig slurry (WS) on the characteristics and emission of NH3, N2O, CO2 and CH4 from solid (SF) and liquid fractions (LF). The additives were mixed with WS (5% w/w), followed by separation, in a total of 12 treatments with 3 replicates, including the controls and WS with additives. Gaseous emissions were measured for 30 d by a photoacoustic multigas monitor, and initial characteristics of the slurries were assessed. The results indicated that the separation of the WS modified the initial physicochemical characteristics and increased the GWP emissions of the SF and LF, but not the NH3 losses. However, the addition of additives before separation increased the nutrient value and reduced the GWP emissions from the SF and LF. Additionally, just the additive alum was effective in the reduction of E. coli. The additives led to significant reductions in NH3 and N2O emissions, with higher reductions in NH3 losses for alum (51% for NH3) and similar N2O losses for all additives (70% for N2O) observed, whereas the CO2 and CH4 emissions were reduced by biochar (25% for CO2 and 50% for CH4) and alum (33% for CO2 and 30% for CH4) but not by clinoptilolite. Although the additives had a positive effect on slurry management, it can be concluded that the addition of alum before mechanical separation has the potential to be the best mitigation measure because it improves the nutrient content and sanitation and decreases gaseous losses from slurry management.
Enquadramento: A literacia em saúde é fundamental, e contribui para que os indivíduos tomem decisões fundamentadas para a saúde. Neste âmbito, a literacia em saúde sexual e reprodutiva capacita os indivíduos para uma melhor vivência da sua sexualidade, pois envolve comportamentos individuais, relações e proteção da saúde física e mental. Objetivos: Construir e validar uma escala de literacia em saúde sexual e reprodutiva (ELSSR). Metodologia: Trata-se de um estudo quantitativo, descritivo e correlacional, com uma amostra de 924 estudantes do ensino superior. O processo de validação incluiu o estudo de consistência interna e a análise fatorial, exploratória e confirmatória. Resultados: Obteve-se uma escala de 15 itens, distribuídos por 3 fatores (Literacia em Reproducao, Contracecao e IST; Literacia sobre o Impacto da Gravidez Adolescente; Literacia em Afetos, Abuso e Exploracao Sexual e Violência no Namoro), que explicam 77,761% da variância. A consistência interna da escala foi de 0.964. O instrumento apresenta boa consistência interna. Conclusão: O instrumento revelou-se válido e fiável. O desenvolvimento de programas educativos/formativos sobre saúde sexual e reprodutiva podem ajudar os jovens adultos a evidenciar maior literacia em saúde sexual e reprodutiva, com impacto para a saúde física e mental.
An online survey was distributed to consumers in nine countries in order to investigate their perceptions related to causers of food safety risks, types of food associated with food-borne illnesses and the role of actors in the food supply chain. A total of 2723 respondents have participated in the survey. Results indicated that food hygiene has been recognized as the most important issue associated with food safety risks. Consumers considered meat and meat products as well as egg and egg-based products, as types of food that pose the highest risks to consumer's health. Food processors and food inspection services play the most significant role in food supply chains. Results further revealed that country of origin has the highest influence on consumer perception, opposed to gender with the least influence. Overall, results obtained in this study confirmed the role of food hygiene as the predominant factor in ensuring food safety in the mind of consumers and that animal-originated food has been perceived as the type of food holding higher health risk opposed to food of plant origin. At the same time, these results challenge the trust in food processors and food inspection services.
Due to the SARS-COV-2 pandemic, educational institutions are immediately faced with a new challenge to adapt, forcing the transition from face-to-face teaching to distance learning in a short period. Distance education supported by technology is a challenge for educational institutions based on binomial technology/teaching. This paper presents a proposal for an e-learning technology structure, supported by a cluster of servers capable of responding to the requirements of distance learning based on the premises of High Availability, High Performance, Load Balancing. The beginning of this study consisted of a literature review to find the various existing technologies, a way to combine them and create a system capable of providing the necessary functionalities, and whose performance could host all the users of an institution simultaneously. The implemented system results from this combination of technologies and allows its capacity to be scaled at any moment according to momentary needs. In technological terms, the solution was based on a free Linux distribution, the Ubuntu Server installed inside a cluster of servers with VMware ESXi, and a cluster of database nodes based on Gallera technology. The eLearning platform used in this study was Moodle because it is one of the resources most used by institutions. The aspects of teaching, provision of content and execution of evaluation tests, were explored. With the implementation of the presented scenario, it was possible to guarantee the High Availability and load balancing of the platform and guarantee a high performance of the whole solution.
Agriculture has always been a sector with several specificities that call for adjusted interventions from public institutions through agricultural policies. This is not an exception for the context in the European Union where the Common Agricultural Policy has had more impact in some contexts than the national agricultural policies of the member-states. In turn, the profit margins are, in general, narrow and this needs specific financial and economic management. However, the financial, economic instruments, and indicators for farming are, often, ignored, or at least, not sufficiently analysed. From this perspective, the main objective of this study is to assess the net working capital framework across European Union countries and regions, including assessments through types of farming and economic size. Another objective is to analyse the impacts from financial indicators (current ratio, current assets-to-total assets ratio, current liabilities-to-total assets ratio, and debt-to-total assets ratio) on profitability (return on assets) and financial performance (return on equity). For this purpose, data from the Farm Accountancy Data Network were considered, for the period 2004–2018. These data were worked through descriptive analysis, spatial autocorrelation approaches, and panel data regressions. As main conclusions, it is worth noting the diversity of financial realities across the European farming sector and the null impacts from the liquidity ratio on the farms’ performance.
The first step towards rehabilitation actions is deep knowledge of buildings characteristics and their conservation state. Studies comprehending large groups of buildings can be useful when dealing with significant amount of data, positively influencing decision-making processes starting from low level information. This paper describes a methodology that makes use of GIS-based maps to visualize the results of cluster analysis regarding defects in 495 buildings. This information was organized to apply a clustering technique with the purpose of identifying patterns related with defects. The GIS-based maps were created to support the interpretation of the clustering results. Conclusions regarding the most interesting number of clusters were drawn, as well as insights on the correlation between the spatial distribution of buildings and the defects observed. In two of the four analyses conducted, a pattern of buildings located in the central area of the historical zone was identified, which was associated with a higher number of defects probably related with the age of the constructions. These results are particularly relevant considering the definition of future rehabilitation actions and confirm the advantage of combining both tools, which is particularly meaningful in contexts where methodologies like this are scarce and limited in number.
Mexico is a multi‐diverse country where insect consumption has been associated with traditional practices. Nevertheless, there are no studies regarding differences in entomophagy within the country to get specific insights into consumers' perceptions. A total of 3,125 Mexicans answered a national survey related to demographic indicators and aspects of edible insects. The χ2 test was used (p<0.05) to analyze the data. Results showed that a national average of 74% had consumed insects, mainly from the south and center. Demographic characteristics demonstrated that the northern region had a significantly higher monthly income (>952 USD) and educational level (postgraduate), declaring a consumption of “once in a lifetime” (more than 50%). The word clouds analysis showed remarkable differences among regions, in the north and center the word "curiosity" was the most found; in the central region, the word "chapulines" (grasshoppers); and in the south, the term "gastronomy". Marketing aspects such as availability, price, and variety significantly trigger increasing insect consumption by understanding regional differences to produce specific strategies and formulations.
Although entrepreneurial failure (EF) is a fairly recent topic in entrepreneurship literature, the number of publications has been growing dynamically and particularly rapidly. Our systematic review maps and integrates the research on EF based on a multi-method approach to give structure and consistency to this fragmented field of research. The results reveal that the field revolves around six thematic clusters of EF: 1) Soft underpinnings of EF, 2) Contextuality of EF, 3) Perception of EF, 4) Two-sided effects of EF, 5) Multi-stage EF effects, and 6) Institutional drivers of EF. An integrative framework of the positive and negative effects of entrepreneurial failure is proposed, and a research agenda is suggested.
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