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The presence of cardiac shunts in ectothermic tetrapods is thought to be consistent with active vascular modulations for proper hemodynamic support. Local control of blood flow modulates tissue perfusion and thus systemic conductance (Gsys) is assumed to increase with body temperature (Tb) to accommodate higher aerobic demand. However, the general increase of Gsys presses for a higher right-to-left (R-L) shunt, which reduces arterial oxygen concentration. In contrast, Tb reduction leads to a Gsys decrease and a left-to-right shunt, which purportedly increases pulmonary perfusion and plasma filtration in the respiratory area. This investigation addressed the role of compensatory vascular adjustments in the face of the metabolic alterations caused by Tb change in the South American rattlesnake (Crotalus durissus). Cardiovascular recordings were performed in decerebrated rattlesnake preparations at 10, 20 and 30°C. The rise in Tb increased metabolic demand, and correlated with an augmentation in heart rate. Although cardiac output increased, systemic stroke volume reduced while pulmonary stroke volume remained stable. Although that resulted in a proportionally higher increase in pulmonary blood flow, the R-L shunt was maintained. While the systemic compliance of large arteries was the most relevant factor in regulating arterial systemic blood pressure, peripheral conductance of pulmonary circulation was the major factor influencing the final cardiac shunt. Such dynamic adjustment of systemic compliance and pulmonary resistance for shunt modulation has not been demonstrated before and contrasts with previous knowledge on shunt control.

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Background: social support is important for adaptation in chronic diseases, such as diabetes and depression, because it favors recovery and adherence to treatment. Introducing its evaluation in the follow-up of diabetic patients can reduce complications derived from secondary non-adherence. Aims: to establish social support in diabetic patients and its correlation with depressive symptoms. Methods: a cross-sectional analytical study nested in a cohort of 173 recently diagnosed diabetic patients (<6 months) in Colombia over 18 years of age, treated in a cardiovascular risk program in 2022. The Chronic Illness Social Support Inventory was used. Results: Most of the participants were women (77.5%); single(83.8%), age (mean = 62.6 years (SD 12.3)); glycemia (mean = 146.4 (SD 65.5)), glycosylated hemoglobin (mean = 7.6 (SD 1.7)). Cronbach's α coefficient for the general scale of the social support instrument was 0.9859. The mean social support was 168.5 (SD 37.4), range 38-228. The total social support score was normally distributed (Shapiro Wilk p > 0.05). The correlation between domains was statistically significant. The PHQ9 total score was significantly associated with the domains of Personal Interaction and Guide but did not significantly correlate with the overall social support score. The respondents who were at risk of developing depression were referred for treatment. Conclusions: findings suggest that perceived social support may play a significant role in the prevention and treatment of depression in diabetic patients. It is desirable that health professionals consider evaluating and enhancing social support to improve their mental health. More research is needed to gain a comprehensive understanding of this relationship.

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Objective: To determine the predictive role of resilience and hope on adherence to treatment in hemodialysis patients hospitalized in two hospitals affiliated to Shiraz University of Medical Sciences (Shiraz, Iran). Methods: This is a descriptive-analytical study that was conducted in 2021-2022 on 120 patients treated in hemodialysis sections in Namazi and Shahid Faqihi teaching hospitals. Sampling was conducted using a stratified random method. Demographic information questionnaires, Connor and Davidson's resilience, Snyder's hope and adherence to kidney patients' treatment questionnaires were used to collect the data. Results: The finds showed that the levels of resilience, hope, and adherence to treatment had hight level. More specifically, it was indicated that the mean and standard deviation for the total resilience score, the hope variable, and adherence to total treatment was 75.45±14.34, 40.43±3.66, and 80.12±18.20, respectively; which have maximum possible scores of 100, 48 and 100. Thus, it can be said that no correlation was observed between resilience and adherence to treatment variables (p>0.05); hope variable and adherence to treatment (p>0.05), and adherence to treatment with hope and resilience variables (p>0.05). However, hope and resilience variables showed a direct and weak correlation with each other (r=0.36, p<0.05); that is, patients who had more hope indicated better resilience as well. Conclusion: Although in this study we found that the resilience and hope variables were not able to predict the treatment adherence, hope and resilience indicated a direct and weak correlation. It is recommended that nurses should pay more attention to hope and resilience of hemodialysis patients in order to promote their health.

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PURPOSE: An FDA-approved non-invasive intracranial pressure (ICP) monitoring system enables the assessment of ICP waveforms by revealing and analyzing their morphological variations and parameters associated with intracranial compliance, such as the P2/P1 ratio and time-to-peak (TTP). The aim of this study is to characterize intracranial compliance in healthy volunteers across different age groups. METHODS: Healthy participants, both sexes, aged from 9 to 74 years old were monitored for 5 min in the supine position at 0º. Age was stratified into 4 groups: children (≤ 7 years); young adults (18 ≤ age ≤ 44 years); middle-aged adults (45 ≤ age ≤ 64 years); older adults (≥ 65 years). The data obtained was the non-invasive ICP waveform, P2/P1 ratio and TTP. RESULTS: From December 2020 to February 2023, 188 volunteers were assessed, of whom 104 were male, with a median (interquartile range) age of 41 (29-51), and a median (interquartile range) body mass index of 25.09 (22.57-28.04). Men exhibited lower values compared to women for both the P2/P1 ratio and TTP (p < 0.001). There was a relative rise in both P2/P1 and TTP as age increased (p < 0.001). CONCLUSIONS: The study revealed that the P2/P1 ratio and TTP are influenced by age and sex in healthy individuals, with men displaying lower values than women, and both ratios increasing with age. These findings suggest potential avenues for further research with larger and more diverse samples to establish reference values for comparison in various health conditions. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (RBR-9nv2h42), retrospectively registered 05/24/2022. UTN: U1111-1266-8006.

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As doenças crônicas não transmissíveis (DCNT) são as principais causas de morbimortalidade no mundo, causando 738.371 óbitos em 2019 no Brasil. Entre elas, há a diabetes mellitus (DM), uma doença que acarreta a hiperglicemia, resultante da deficiência na secreção e/ou ação da insulina. Além das complicações, pacientes com DM apresentam elevado sofrimento emocional, incidindo sobre o autocuidado com o tratamento, a alimentação, a atividade física, entre outros aspectos que afetam sua qualidade de vida. Nessa perspectiva, este estudo objetiva avaliar a aderência ao autocuidado nos pacientes com DM cadastrados em dois Centros de Saúde no município de Campinas, em São Paulo. Estudo de caráter exploratório descritivo, a coleta de dados foi realizada a partir do Questionário de Atividades do Autocuidado com o Diabetes (QAD), adaptado e validado para a cultura brasileira a partir do The Summary of Diabetes Self-Care Activities Measure (SDSCA). Os dados foram analisados mediante tabulação no programa EPI INFO versão 3.5.1. A partir dos achados, os centros de saúde poderão fortalecer a linha de cuidado de indivíduos com diagnóstico de DM, direcionando as ações educativas na prevenção de complicações, permitindo maior independência e autonomia do paciente e aprimorando a adesão ao tratamento.

Chronic Non-Communicable Diseases (NCDs) are the main causes of morbidity and mortality worldwide. In 2019, 738,371 deaths were reported due to NCDs in Brazil. Among them is Diabetes Mellitus (DM), a disease that causes hyperglycemia from a deficiency in insulin secretion and/or action. In addition to complications, DM patients experience high emotional suffering which affects self-care treatment, nutrition, physical activity and other aspects that impact their quality of life. In this perspective, this study evaluates adherence to self-care treatment in DM patients registered in two health centers in Campinas, São Paulo. An exploratory, descriptive study was conducted using data collected by the Diabetes Self-Care Activities Questionnaire (QAD), adapted and validated for Brazil using the Summary of Diabetes Self-Care Activities Measure (SDSCA). Data were analyzed using tabulation in the EPI INFO program version 3.5.1. Based on the findings, health centers may strengthen their line of care for individuals diagnosed with DM, directing educational actions towards preventing complications, allowing greater patient independence and autonomy, thus improving treatment adherence.

Las enfermedades crónicas no transmisibles (ENT) están entre las principales causas de morbimortalidad en el mundo; en 2019 se reportaron en Brasil 738.371 muertes por ENT. Entre las ENT, se encuentra la diabetes mellitus (DM), una afección que causa hiperglucemia y que resulta de una deficiencia en la secreción y/o acción de la insulina. Además de sus complicaciones, los pacientes con DM experimentan un alto sufrimiento emocional, lo que afecta el autocuidado con el tratamiento, la nutrición, la actividad física y otros aspectos relacionados a la calidad de vida. Desde esta perspectiva, este estudio tiene como objetivo evaluar la adherencia al autocuidado en pacientes con DM registrados en dos centros de salud de la ciudad de Campinas, en São Paulo (Brasil). Se trata de un estudio exploratorio, descriptivo, en el cual la recolección de datos se realizó mediante el Cuestionario de Actividades de Autocuidado de la Diabetes (QAD), adaptado y validado para la cultura brasileña mediante el Resumen de las Actividades de Autocuidado de la Diabetes (SDSCA). Los datos se analizaron mediante tabulación en el programa EPI INFO, versión 3.5.1. Los hallazgos apuntan a que los centros de salud podrán fortalecer la línea de atención a las personas diagnosticadas con DM desde acciones educativas sobre la prevención de complicaciones, permitiendo mayor independencia y autonomía del paciente y mejorando así la adherencia al tratamiento.

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Objective. To determine the predictive role of resilience and hope on adherence to treatment in hemodialysis patients hospitalized in two hospitals affiliated to Shiraz University of Medical Sciences (Shiraz, Iran). Methods. This is a descriptive-analytical study that was conducted in 2021-2022 on 120 patients treated in hemodialysis sections in Namazi and Shahid Faqihi teaching hospitals. Sampling was conducted using a stratified random method. Demographic information questionnaires, Connor and Davidson's resilience, Snyder's hope and adherence to kidney patients' treatment questionnaires were used to collect the data. Results. The finds showed that the levels of resilience, hope, and adherence to treatment had hight level. More specifically, it was indicated that the mean and standard deviation for the total resilience score, the hope variable, and adherence to total treatment was 75.45±14.34, 40.43±3.66, and 80.12±18.20, respectively; which have maximum possible scores of 100, 48 and 100. Thus, it can be said that no correlation was observed between resilience and adherence to treatment variables (p>0.05); hope variable and adherence to treatment (p>0.05), and adherence to treatment with hope and resilience variables (p>0.05). However, hope and resilience variables showed a direct and weak correlation with each other (r=0.36, p<0.05); that is, patients who had more hope indicated better resilience as well. Conclusion. Although in this study we found that the resilience and hope variables were not able to predict the treatment adherence, hope and resilience indicated a direct and weak correlation. It is recommended that nurses should pay more attention to hope and resilience of hemodialysis patients in order to promote their health.

Objetivo. Determinar el papel predictivo de la resiliencia y la esperanza en la adherencia al tratamiento en pacientes en hemodiálisis internados en dos hospitales afiliados a la Universidad de Ciencias Médicas de Shiraz (Shiraz, Irán). Métodos. Se trata de un estudio descriptivo-analítico que se realizó en 2021-2022 con la participación de 120 pacientes tratados en secciones de hemodiálisis en los hospitales docentes Namazi y Shahid Faqihi. El muestreo se realizó mediante un método aleatorio estratificado. Para la recogida de datos se utilizaron datos demográficos y las escalas de resiliencia de Connor y Davidson, de esperanza de Snyder y de adherencia al tratamiento de pacientes renales. Resultados. Los hallazgos mostraron que los niveles de resiliencia, esperanza y adherencia al tratamiento se encontraban en niveles altos. Más concretamente, se indicó que la media y la desviación estándar para la puntuación total de resiliencia, la variable esperanza y la adherencia al tratamiento total fueron 75.45±14.34, 40,43±3.66 y 80.12±18.20, respectivamente; las cuales tienen como puntajes máximos posibles 100, 48 y 100. No se observó correlación entre las variables: resiliencia y adherencia al tratamiento (p>0.05), esperanza y la adherencia al tratamiento (p>0.05), y adherencia al tratamiento y las variables esperanza y resiliencia (p>0.05). Sin embargo, las variables esperanza y resiliencia mostraron una correlación directa y débil entre sí (r=0.36, p<0.05); es decir, los pacientes que tenían más esperanza indicaron también mejor resiliencia. Conclusión. Aunque en este estudio encontramos que las variables resiliencia y esperanza no fueron capaces de predecir la adherencia al tratamiento, la esperanza y la resiliencia indicaron una correlación directa y débil. Se recomienda que el personal de enfermería preste más atención a la esperanza y la resiliencia de los pacientes en hemodiálisis para promover su salud.

Objetivo. Determinar o papel preditivo da resiliência e da esperança na adesão ao tratamento em pacientes em hemodiálise internados em dois hospitais afiliados à Universidade de Ciências Médicas de Shiraz (Shiraz, Irã). Métodos. Trata-se de um estudo descritivo-analítico realizado em 2021-2022 com a participação de 120 pacientes atendidos nas seções de hemodiálise dos hospitais universitários Namazi e Shahid Faqihi. A amostragem foi realizada por método aleatório estratificado. Para a coleta de dados foram utilizados dados demográficos e as escalas de resiliência de Connor e Davidson, escalas de esperança de Snyder e adesão ao tratamento de pacientes renais. Resultados As descobertas mostraram que os níveis de resiliência, esperança e adesão ao tratamento estavam em níveis elevados. Mais especificamente, foi indicado que a média e o desvio padrão do escore de resiliência total, da variável esperança e da adesão total ao tratamento foram 75.45±14.34, 40.43±3.66 e 80.12±18.20, respectivamente; que possuem as pontuações máximas possíveis de 100, 48 e 100. Não foi observada correlação entre as variáveis: resiliência e adesão ao tratamento (p>0.05), esperança e adesão ao tratamento (p>0.05), e adesão ao tratamento e esperança e variáveis de resiliência (p>0.05). Contudo, as variáveis esperança e resiliência apresentaram correlação direta e fraca entre si (r=0.36, p<0.05); Ou seja, os pacientes mais esperançosos também indicaram melhor resiliência. Conclusão. Embora neste estudo tenhamos constatado que as variáveis resiliência e esperança não foram capazes de predizer a adesão ao tratamento, a esperança e a resiliência indicaram uma correlação direta e fraca. Recomenda-se que a equipe de enfermagem preste mais atenção à esperança e à resiliência dos pacientes em hemodiálise para promover sua saúde.

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Neurocritical patients frequently exhibit abnormalities in cerebral hemodynamics (CH) and/or intracranial compliance (ICC), all of which significantly impact their clinical outcomes. Transcranial Doppler (TCD) and the cranial micro-deformation sensor (B4C) are valuable techniques for assessing CH and ICC, respectively. However, there is a scarcity of data regarding the predictive value of these techniques in determining patient outcomes. We prospectively included neurocritical patients undergoing intracranial pressure (ICP) monitoring within the first 5 days of hospital admission for TCD and B4C assessments. Comprehensive clinical data were collected alongside parameters obtained from TCD (including the estimated ICP [eICP] and estimated cerebral perfusion pressure [eCPP]) and B4C (measured as the P2/P1 ratio). These parameters were evaluated individually as well as in combination. The short-term outcomes (STO) of interest were the therapy intensity levels (TIL) for ICP management recommended by the Seattle International Brain Injury Consensus Conference, as TIL 0 (STO 1), TIL 1-3 (STO 2) and death (STO 3), at the seventh day after last data collection. The dataset was randomly separated in test and training samples, area under the curve (AUC) was used to represent the noninvasive techniques ability on the STO prediction and association with ICP. A total of 98 patients were included, with 67% having experienced severe traumatic brain injury and 15% subarachnoid hemorrhage, whilst the remaining patients had ischemic or hemorrhagic stroke. ICP, P2/P1, and eCPP demonstrated the highest ability to predict early mortality (p = 0.02, p = 0.02, and p = 0.006, respectively). P2/P1 was the only parameter significant for the prediction of STO 1 (p = 0.03). Combining B4C and TCD parameters, the highest AUC was 0.85 to predict death (STO 3), using P2/P1 + eCPP, whereas AUC was 0.72 to identify ICP > 20 mmHg using P2/P1 + eICP. The combined noninvasive neuromonitoring approach using eCPP and P2/P1 ratio demonstrated improved performance in predicting outcomes during the early phase after acute brain injury. The correlation with intracranial hypertension was moderate, by means of eICP and P2/P1 ratio. These results support the need for interpretation of this information in the ICU and warrant further investigations for the definition of therapy strategies using ancillary tests.

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Introduction: During the first years of the pandemic, COVID-19 forced governments worldwide to take drastic measures to reduce the spread of the virus. Some of these measures included mandatory confinements, constant use of masks, and social distancing. Despite these measures being mandatory in many countries and the abundance of evidence on their effectiveness at slowing the spread of the virus, many people failed to comply with them. Methods: This research explored the role of cognitive factors in predicting compliance with COVID-19 safety measures across two separate studies. Building on earlier work demonstrating the relevance of cognitive processes in health behaviour, this study aimed to identify key predictors of adherence to safety guidelines during the pandemic. Utilising hierarchical regression models, we investigated the influence of age, sex, cognitive control, cognitive flexibility (Study 1), working memory, psychological health, and beliefs about COVID-19 (Study 2) on compliance to biosafety measures. Results: Demographic variables and cognitive control were significant predictors of compliance in both studies. However, cognitive flexibility and working memory did not improve the models' predictive capacities. In Study 2, integrating measures of psychological health and beliefs regarding COVID-19 severity significantly improved the model. Further, interaction effects between age and other variables also enhanced the predictive value. Discussion: The findings emphasise the significant role cognitive control, age, psychological health, and perceptions about COVID-19 play in shaping compliance behaviour, highlighting avenues for targeted interventions to improve public health outcomes during a pandemic.

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Resumen Introducción : Hay escasa evidencia sobre el impacto de la pandemia de COVID-19 en el cumplimiento del tratamiento de cáncer cervicouterino. Métodos : Se llevó a cabo un estudio poblacional de cohorte retrospectivo. -antes/después- de las pacientes con cáncer cervicouterino diagnosticadas en estable cimientos públicos de la provincia de Jujuy (n = 140), entre 2017 y 2020. Las pacientes diagnosticadas en 2020 se consideraron expuestas a la pandemia (n = 21). Utili zamos la regresión logística multivariada para analizar la asociación entre pandemia y cumplimiento del tra tamiento de cáncer. Además, se midió la duración del tratamiento en aquellas con indicación de braquiterapia y el tiempo hasta el inicio al tratamiento según estadio. Resultados : Comparadas con las mujeres diagnosti cadas en 2017-2019 el odds ratio de incumplimiento del tratamiento fue de 1.77 (IC95% 0.59-5.81; p = 0.32) para las diagnosticadas durante 2020. Se encontró un mayor riesgo de incumplimiento en pacientes con indicación de braquiterapia (OR 4.14; IC 95%:1.95-9.11; p < 0.001). La mediana de duración del tratamiento para aquellas con indicación de braquiterapia fue de 12.8 y 15.7 sema nas en 2017-2019 y 2020 respectivamente (p = 0.33). La mediana de tiempo hasta el inicio del tratamiento para pacientes con enfermedad en estadio temprano fue de 9 y 5 semanas durante 2017-2019 y 2020 respectivamente (p = 0.06), versus una mediana de 7.2 y 9 semanas en 2017-2019 y 2020 respectivamente (p=0.36) para las pa cientes con enfermedad en estadio IIB+. Conclusiones : El bajo acceso a la braquiterapia fue un factor determinante de incumplimiento de tratamiento de cáncer cervicouterino, independientemente del efecto de la pandemia.

Abstract Introduction : Little evidence exists on the impact of the COVID-19 pandemics on the compliance with cervi cal cancer treatment. Methods : We carried out a population-based, be fore-and-after retrospective cohort study of all cervical cancer patients diagnosed in the Jujuy province public health sector (n=140), Argentina, between 2017 and 2020. Patients diagnosed in 2020 were considered exposed to the COVID-19 pandemic (n=21). We used multivariable logistic regression to assess the relationship between the pandemics and compliance with treatment. We also measured treatment duration for women who were indicated brachytherapy and time to treatment initia tion by stage. Results : Compared with women diagnosed in 2017- 2019 the odds ratio of non-complying with treatment was 1.77 (95%CI 0.59-5.81; p = 0.32) for women diagnosed during 2020. An increased risk of non-compliance was found in patients with prescribed brachytherapy (OR 4.14. 95%CI 1.95-9.11; p < 0.001). Median treatment dura tion for women with prescribed brachytherapy was 12.8 and 15.7 weeks in 2017-2019 vs. 2020 (p = 0.33); median time to treatment initiation for women with early-stage disease was 9 and 5 weeks during 2017-2019 and 2020 respectively (p = 0.06), vs 7.2 and 9 weeks in 2017-2019 and 2020 respectively (p = 0.36) for patients with stages IIB+ disease. Conclusions : Low access to brachytherapy was a major determinant of non-compliance. irrespective of the effect of the pandemics.