O presente estudo, de abordagem qualitativa, visa compreender como o brincar integrado na prática de enfermagem pode ser usado na gestão do estado emocional da criança a viver uma experiência de hospitalização/cirurgia. Neste processo investigativo recorreu-se ao diário de campo para descrever e analisar a própria prática de enfermagem associada ao fenómeno em estudo. A recolha dos dados foi realizada num serviço de internamento de pediatria cirúrgica de um hospital pediátrico de Lisboa, no período de Abril a Junho de 2008, a partir de interacções de cuidados com 9 crianças de idades compreendidas entre os 6 e os 8 anos. Os dados foram analisados segundo a técnica de análise de conteúdo, os quais revelaram um processo de gestão do estado emocional da criança, através da actividade de brincar, que implica as seguintes acções/interacções: promover o confronto adaptativo, favorecer o relaxamento, incrementar o sentimento de controlo, promover o sentimento de segurança, facilitar a aproximação, promover a expressão emocional, minimizar o sentimento de solidão, promover a distracção e desmistificar os medos. Conclui-se que a actividade de brincar é um instrumento terapêutico primordial em enfermagem pediátrica, na medida em que se revela um meio para favorecer o bem-estar das crianças, e por isso é sugestivo de contribuir para resultados terapêuticos. De facto, usado de modo intencional e sistemático promove a adaptação e aprendizagem das crianças numa experiência positiva de hospitalização/cirurgia.

O aneurisma da veia popliteia (AVP) é uma entidada rara mas que comporta um risco importante de trombose venosa profunda (TVP) e consequente tromboembolismo pulmonar (TEP). Uma vez que a anticoagulação não é eficaz na prevenção dessas complicações, a cirurgia é o tratamento indicado pela quase totalidade dos autores. Apresentamos dois casos tratados no nosso serviço que ilustram o caráter pleomórfico desta doença – o primeiro manifestando-se como uma massa popliteia pouco sintomática e o segundo como um quadro semelhante a TVP numa doente cuja mãe falecera por TEP de causa não esclarecida. Ambos foram tratados pela técnica de aneurismectomia com venorrafia lateral, com bom resultado confirmado imagiologicamente ao fim de 6 meses. Fazemos ainda uma discussão com base na literatura. O AVP é uma entidade rara e de etiologia não esclarecida, cuja principal complicação é o TEP. O tratamento cirúrgico é a abordagem de eleição. A técnica cirúrgica utilizada de aneurismectomia com venorrafia lateral apresenta bons resultados e pode ser considerada curativa. Por esses motivos é uma doença a considerar no diagnóstico diferencial quer de massas popliteias quer de fenómenos tromboembólicos de repetição.

AIM: The aim of the study was to evaluate the effectiveness of a 10-week combined training programme (aerobic and strength exercise) compared to an aerobic training programme, and respiratory physiotherapy on COPD patients' health. METHODS: Fifty subjects with moderate to severe COPD were randomly assigned to two groups. Combined group (CG, n=25) who underwent combined training, and aerobic group (AG, n=25) who underwent aerobic training. These were compared with fifty COPD subjects who underwent respiratory physiotherapy, breathing control and bronchial clearance techniques (RP group, n = 50). We evaluated health state through two questionnaires, St. George's Respiratory Questionnaire (SGRQ) and SF-36, at the beginning and at the end of the programme. RESULTS: The CG group showed differences (p<0.0001) in modification rates in state of health compared to the AG and RP groups in the activity (64 ± 9%, 19 ± 7%, 1 ± 15%) , impact (35 ± 5%, 20 ± 18%, 1 ± 14%) and total (41 ± 9%, 26 ± 17%, 1 ± 15%) domains assessed by the SGRQ, and the physical function (109 ± 74%, 22 ± 12%, 0.1 ± 18%), physical role (52 ± 36%, 11 ± 15%, 1.3 ± 21%) and vitality (83 ± 39%, 14 ± 38%) domains assessed by SF-36. CONCLUSION: These results suggest that combined training in subjects with COPD appears to be a more effective method, with better clinical changes, and improvements in health state perception.

Objectives. To describe clinical manifestations and performed diagnostic workup, focusing drug challenge tests (DCT), in patients with drug allergy. Methods. Retrospective study including all patients with skin tests (STs) or DCT-based drug allergy diagnosis, between 01/2014 - 06/2018 in a Portuguese allergy unit. Data were collected from electronic and paper-based clinical records. Results. We had 75 drug allergy diagnoses. Most index reactions were mild and major or equal 1 hour after drug intake. 59 (78%) diagnoses were based on DCTs, all based on multistep protocols with major or equal 3 predicted steps. Only 10% of the DCT were positive during up-dosing; timing and severity of the index reaction predicted DCT interruption during up-dosing. Conclusions. Most drug allergy diagnoses were based on multistep DCT. The identified predictors of DCT interruption during up-dosing can support the development of more personalized DCTs protocols.

BACKGROUND: We aimed to: 1) estimate the prevalence of exposure to environmental tobacco smoke (ETS) at home in the Portuguese population; 2) estimate tobacco smoking prevalence in Portugal; 3) identify social and personal characteristics associated with smoking or exposure to ETS. METHODS: Nationwide, cross-sectional, population-based telephone survey. Overall, 6003 individuals completed the interview. ETS exposure at home was defined as exposure to at least one current smoker at home. A smoker was defined as someone with 15 years or older, smoking at least 1 cigarette per day during a year; a current smoker (CS) smoked in the last month. RESULTS: Exposure to ETS at home was reported by 26.6% (95%CI 25.5-27.7) of the participants. Living in households with ≥4 persons (OR=2.31; 95%CI[1.81-2.96]), being a current smoker (OR=7.29; 95%CI[5.74-9.26]) or having current asthma (OR=2.06; 95%CI[1.45-2.94]) were factors positively associated with ETS exposure. When analyzed by gender, the effect of current asthma was only relevant to females. Currently 19.0% (95%CI 18.0-20.0) of the Portuguese population smokes tobacco and 17.2% (95%CI 16.2-18.2) are ex-smokers. CS prevalence is higher in males than females (26.5%versus 12.2%, p<0,001). The odds of being a CS were higher for males, the more educated, and those exposed to ETS at home. When analyzed by gender, school education only affected females. CONCLUSION: Exposure to ETS at home was higher than previously reported. Children/adolescents and asthma patients may have a higher risk of exposure. This report endorses a decreasing trend in the prevalence of tobacco smoking in Portuguese males, but a tendency to increase in females.

Most mobile health (mHealth) decision support systems currently available for chronic obstructive respiratory diseases (CORDs) are not supported by clinical evidence or lack clinical validation. The development of the knowledge base that will feed the clinical decision support system is a crucial step that involves the collection and systematization of clinical knowledge from relevant scientific sources and its representation in a human-understandable and computer-interpretable way. This work describes the development and initial validation of a clinical knowledge base that can be integrated into mHealth decision support systems developed for patients with CORDs. A multidisciplinary team of health care professionals with clinical experience in respiratory diseases, together with data science and IT professionals, defined a new framework that can be used in other evidence-based systems. The knowledge base development began with a thorough review of the relevant scientific sources (eg, disease guidelines) to identify the recommendations to be implemented in the decision support system based on a consensus process. Recommendations were selected according to predefined inclusion criteria: (1) applicable to individuals with CORDs or to prevent CORDs, (2) directed toward patient self-management, (3) targeting adults, and (4) within the scope of the knowledge domains and subdomains defined. Then, the selected recommendations were prioritized according to (1) a harmonized level of evidence (reconciled from different sources); (2) the scope of the source document (international was preferred); (3) the entity that issued the source document; (4) the operability of the recommendation; and (5) health care professionals' perceptions of the relevance, potential impact, and reach of the recommendation. A total of 358 recommendations were selected. Next, the variables required to trigger those recommendations were defined (n=116) and operationalized into logical rules using Boolean logical operators (n=405). Finally, the knowledge base was implemented in an intelligent individualized coaching component and pretested with an asthma use case. Initial validation of the knowledge base was conducted internally using data from a population-based observational study of individuals with or without asthma or rhinitis. External validation of the appropriateness of the recommendations with the highest priority level was conducted independently by 4 physicians. In addition, a strategy for knowledge base updates, including an easy-to-use rules editor, was defined. Using this process, based on consensus and iterative improvement, we developed and conducted preliminary validation of a clinical knowledge base for CORDs that translates disease guidelines into personalized patient recommendations. The knowledge base can be used as part of mHealth decision support systems. This process could be replicated in other clinical areas.

At a time of unprecedented human population growth, climate change, and losses in biodiversity, plant reproduction is a particularly strategic research topic. From the very moment that a sporophytic cell switches its developmental pathway to become the megasporocyte or microsporocyte until a seed is finally formed, an intricate network of tightly regulated signalling pathways is in action. In recent years our understanding of the plant reproductive system has evolved enormously, and at a great pace. This special issue includes a collection of reviews that present the current state of the art across several areas of research in plant reproduction.

Zinc is an essential element, a cofactor of many enzymes, and performs catalytic, structural and regulatory functions. Once in the gastrointestinal tract, zinc can interact with food constituents. Phytic acid, the major phosphorus storage in plants, limits zinc availability from animal feeds due to the formation of insoluble complexes with phytates. This study tested the effect of supplemental zinc source (zinc sulfate and a chelate zinc proteinate) and the addition of exogenous enzymes from a solid-state fermentation product of Aspergillus niger to a high phytate diet. The study was designed according to three Latin Squares 4 × 4 with a 2 × 2 factorial arrangement of treatments, with four periods, four diets, and 12 young adult Beagles. Periods lasted 5 weeks each. Diets were supplemented with 75 mg/kg of zinc sulfate (IZ) or zinc proteinate (OZ), and without or with 200 mg/kg of exogenous enzymes (IZ+, OZ+). Results showed that zinc proteinate increased the bioavailability of phosphorus, yet the zinc biomarkers remained unaffected by the zinc source, with the exception of lymphocyte subsets that benefit from zinc proteinate. The use of exogenous enzymes did not affect zinc availability nor nutrient and energy digestibility.

The presence of bees (Apis mellifera L.) in urban areas has increased in recent years due to environmental disturbances caused by humans. Bee migration to cities may provoke serious accidents, since some people present allergic reactions to their venoms. In Rio Claro city, São Paulo state, Brazil, the number of calls to the fire brigade for removal of bee swarms, and the number admissions in local hospitals due to bee stings were investigated during 2002 and 2003, and a correlation between these data and the average temperature, rainfall and relative humidity was found. The study period was divided into three phases according to the number of times that the fire brigade was called to remove swarms (263 times): January to July 2002 - 51 calls (19.39%); August 2002 to July 2003 - 140 calls (53.23%); and August to December 2003 - 72 calls (27.38%). A significant correlation among the number of calls, the local temperature and rainfall was detected. The number of accidents was not associated with environmental variables. Based on the current results, public activities for prevention of bee attacks may be developed to avoid unwanted contact between humans and these insects, and/or provide the appropriate management of the colonies.

The presence of bees (Apis mellifera L.) in urban areas has increased in recent years due to environmental disturbances caused by humans. Bee migration to cities may provoke serious accidents, since some people present allergic reactions to their venoms. In Rio Claro city, São Paulo state, Brazil, the number of calls to the fire brigade for removal of bee swarms, and the number admissions in local hospitals due to bee stings were investigated during 2002 and 2003, and a correlation between these data and the average temperature, rainfall and relative humidity was found. The study period was divided into three phases according to the number of times that the fire brigade was called to remove swarms (263 times): January to July 2002 - 51 calls (19.39%); August 2002 to July 2003 - 140 calls (53.23%); and August to December 2003 - 72 calls (27.38%). A significant correlation among the number of calls, the local temperature and rainfall was detected. The number of accidents was not associated with environmental variables. Based on the current results, public activities for prevention of bee attacks may be developed to avoid unwanted contact between humans and these insects, and/or provide the appropriate management of the colonies.