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The principle and practice of pro bono, or volunteer legal services for poor and other marginalized groups, is an increasingly important feature of civil justice systems around the world. Recent surveys have identified pro bono initiatives in more than eighty countries - including Colombia, Portugal, Nigeria, and Singapore - and the list keeps growing. Covering the spread of pro bono in across five continents, this book provides a unique comparative dataset permitting the first-ever analysis of pro bono's growing role in access to justice globally. The contributors are leading experts from around the world, whose chapters explore both the internal roots of and global influences on pro bono in transnational context. Global Pro Bono explores the dramatically expanding geographical and political reach of pro bono: documenting its essential contribution to bringing more justice to those on the margins, while underscoring its complex and contested meaning in different parts of the world.
Reducing sedentary behaviour (SB) and increasing physical activity (PA) by sitting less and standing/walking more is advised to prevent chronic diseases. However, the mechanisms underlying this recommendation are not well-established, especially in individuals with obesity living in low-income regions. The present study evaluated whether there are associations between PA indicators (PAI – standing time, walking time, and the number of steps/day) and SB indicators (SBI - sitting/lying down time) with the hormonal profile and resting energy expenditure (REE) of adult women living in a low-income region. This is a cross-sectional study. We collected data on hormones (insulin resistance, leptin, and thyroid axis), body composition (tetrapolar bioimpedance), REE (indirect calorimetry), and PAI and SBI (triaxial accelerometers, ActivPAL). Multivariable linear models adjusting for age and fat-free mass were performed. Fifty-eight women (mean age of 31 years and body mass index of 33 kg/m2) were included. The mean sitting/lying down time and standing time were 16.08 and 5.52 h/day, respectively. Sitting/lying down time showed a direct association with free thyroxine (FT4) (β = 0.56 ng/dL; 95%CI = −1.10; −0.02). Standing time showed a direct association with FT4 (β = 0.75 ng/dL; 95% CI = 0.01; 1.48) and inverse association with free triiodothyronine (β = −2.83 pg/mL 95%CI = −5.56; −0.10). There were no associations between PAI and SBI with the REE, insulin resistance, leptin and thyroid-stimulating hormone. Thus, decreased SB is associated with thyroid hormones levels but not with REE, insulin resistance or leptin in women with obesity living in low-income regions.
The diagnosis of visceral leishmaniasis (VL) has improved with the search of novel antigens; however, their performance is limited when samples from VL/human immunodeficiency virus (HIV)-coinfected patients are tested. In this context, studies conducted to identify more suitable antigens to detect both VL and VL/HIC coinfection cases should be performed. In the current study, phage display was performed using serum samples from healthy subjects and VL, HIV-infected and VL/HIV-coinfected patients; aiming to identify novel phage-exposed epitopes to be evaluated with this diagnostic purpose. Nine non-repetitive and valid sequences were identified, synthetized and tested as peptides in enzyme-linked immunosorbent assay experiments. Results showed that three (Pep2, Pep3 and Pep4) peptides showed excellent performance to diagnose VL and VL/HIV coinfection, with 100% sensitivity and specificity values. The other peptides showed sensitivity varying from 50.9 to 80.0%, as well as specificity ranging from 60.0 to 95.6%. Pep2, Pep3 and Pep4 also showed a potential prognostic effect, since specific serological reactivity was significantly decreased after patient treatment. Bioinformatics assays indicated that Leishmania trypanothione reductase protein was predicted to contain these three conformational epitopes. In conclusion, data suggest that Pep2, Pep3 and Pep4 could be tested for the diagnosis of VL and VL/HIV coinfection.
Dementia is a major cause of disability worldwide. About 25%-40% of patients with mild to moderate dementia are affected by sleep-awake cycle disturbances, including increased daytime sleepiness and insomnia. However, little is known about the specific impact of excessive daytime sleepiness on the cognitive decline of dementia patients.
To evaluate the impact of daytime sleepiness on the cognitive decline of dementia patients. Additionally, longitudinal associations with functional impairment and neuropsychiatric symptoms will be explored.
A longitudinal study will be conducted in a psychogeriatric consultation. Patients will be consecutively invited according to predefined eligibility criteria. Those aged ≥65 years, with dementia diagnosis or Mini-Mental State Examination (MMSE) <24, and with a knowledgeable caregiver, will be included. The exclusion criteria are: a caregiver <18 years, terminally ill, incapable to communicate or with a known diagnosis of insomnia, sleep related respiratory disorders, central hyperinsomnia, restless legs syndrome or sleep paralysis. Participants will undergo an assessment with a comprehensive protocol including: Montreal Cognitive Assessment (MoCA), Barthel and Lawton Index, Epworth Sleepiness Scale (ESS), Neuropsychiatric Inventory (NPI) and Global Deterioration Scale (GDS). Participants will be re-assessed 6 months after the initial evaluation. The Health Ethics Committee of Hospital Universitário de São João granted the study authorization (nº 260/2020).
Findings will be disseminated via publication in peer-reviewed journals and presentations at national and international scientific conferences.
This study will address key questions on the relation of daytime sleepiness and dementia outcomes, in order to undertake corrective and preventive non-pharmacological and pharmacological approaches.
Depression is commonly present among HF patients and is associated with adverse clinical outcomes. However, research regarding its association with New York Heart Association (NYHA) class is still scarce.
To evaluate the presence of depression symptoms in HF outpatients and analyze its association with NYHA class.
This study is part of a larger research project (Deus Ex-Machina/NORTE-01-0145-FEDER-00026). HF patients were recruited from an outpatient clinic at a University Hospital. Exclusion criteria were: unable to communicate, severe visual acuity deficit or NYHA class IV. Sociodemographic data and NYHA class were registered. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, with a score ≥10 indicating clinically relevant depression.
A sample of 136 HF patients was included, with a median age of 59 (range: 24-81) years old, where 66% were men. Almost half of the patients (49%) were in NYHA class II, followed by class I (36%) and class III (15%). The median score of PHQ-9 was 4(range:0-18), with 26% showing clinically relevant depression. PHQ-9 total score was associated with NYHA class (p=0.001), with higher median scores in worse NYHA classes [class I: 3 (IQR: 5.5), class II: 4 (IQR: 8) and class III: 8.5 (IQR:9.3)].
In this study, depression was present in 26% of HF outpatients and was associated with more severe HF symptoms. Consequently, preventing, monitoring, and treating depression in the management of these patients is recommended. Further research is needed for a deeper analysis of this association.
COVID-19 is a respiratory disease and its main symptoms are fever, dry cough and difficulty breathing. It spread to several countries, which led the World Health Organization to decree, on March 11, 2020, a pandemic state that deeply affected Brazil. Due to the impossibility of leaving the house, the routine of children with autism was changed. Children in Autism Spectrum Disorder (ASD) have a qualitative deficit in social interaction. Clinical and daily observations reinforce several scientific studies that defend the importance of maintaining a routine as stable as possible for people with ASD, without this stability they may become emotionally disorganized, feel discomfort or even irritability.
Investigate the impact caused by social distancing on the development of children and adolescents with autism.
An online questionnaire based on the DIR/Floortime basic map of emotional functional capacity development was distributed in Brazil from April to May, 2020. The results were analyzed using SPSS software.
Results obtained from 122 questionnaires showed that after 30 days of quarantine 20% of children no longer had the characteristic of being able to remain calm and organized for at least 2 minutes; 11% no longer initiates interactions with their parents; 27% demonstrated more protests and anger than before the social distancing; 18% demonstrated more emotions such as anger, fear and intimacy, 28% began to understand their limits and 12% of the children are using greater facial expression during the social distancing.
This study brings results that can help to understand the processes in a child with autism.
OPEN is a structured intervention program for patients who present with untreated psychosis at an early stage, under the guidance of a case manager and a periodic evaluation performed by a multidisciplinary team.
The aim of the OPEN program is to create an individual care plan, promoting recovery, functionality, quality of life and prevent relapses. One year after implementation of the program, we present the first results.
We performed a retrospective review of the patients’ clinical profiles included in the OPEN program.
Nine patients were included in the program. The most frequent diagnosis was schizophrenia (n=5). By the time of inclusion in the program, 5 patients used cannabis frequently; one patient kept substance use. At the 6th month assessment, 4 in 5 patients showed an improvement in social functioning (Personal and Social Performance Scale; ± 16 points), and a decrease in symptom severity in all (Brief Psychiatric Rating Scale; ± 11 points). Due to COVID-19 pandemics, group interventions were suspended, and some visits were performed by teleconsultation. No patients lost follow-up.
We observed an overall positive result of the first months of this program, regarding both functionality and clinical outcomes. The main obstacle so far is the impossibility of performing group interventions since the start of the contingency measures regarding COVID-19 pandemics. We expect further results of the OPEN program with the inclusion of more patients.
Previous studies have demonstrated that night-shift work is associated with adverse effects impacting physical and psychological health, including the Shift Work Disorder (SWD). SWD is a circadian rhythm disorder characterized by sleepiness and insomnia, resulting from working a shift other than the traditional daytime-shift. Armodafinil, a modafinil longer-lasting R-isomer, is approved for SWD treatment. Due to its pharmacodynamic profile, it may result in more sustained wakefulness during night-shifts than Modafinil.
To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the efficacy of Armodafinil vs Modafinil and/or placebo on reducing SWD excessive sleepiness.
Will follow PRISMA guidelines. A systematic search will be conducted on PubMed, Web of Science, Scopus and ClinicalTrials.gov databases. RCTs comparing Armodafinil with Modafinil and/or Placebo for SWD treatment will be included. No language nor date restrictions will be applied. Outcomes of interest are prespecified as follows: the primary endpoint will be objective sleepiness; secondary endpoints will include subjective sleepiness, adverse effects, awareness, reaction time, memory and cognition. Retrieved studies will be independently screened for eligibility by two reviewers. Disagreements will be solved by consensus or by a third reviewer. Primary studies methodological quality will be assessed and data extracted independently using a standardized extraction-form.
Data will be described and reported as narrative text and summary tables. Heterogeneity of the included studies will be assessed and, if possible, a meta-analysis will be conducted.
It is expected that this systematic review and meta-analysis favours Armodafinil over Modafinil and placebo in the treatment of SWD.
Nowadays we know that autism spectrum disorders (ASD) and Schizophrenic spectrum (SS) are different types of disorders in their etiology, symptoms and prognosis, but the clinical distinction is often difficult to make due to comorbidity and similar symptoms.
With this project, the authors intend to explore the differential diagnosis between ASD and SS specially when we talk about critical ages of onset.
An analysis of articles searched on Pubmed (articles between 2010-2020) with the key words “adult autism”, “childhood onset schizophrenia”, “childhood psychosis”.
Early-onset schizophrenia (EOS) is defined as occurring before age 18 years. The condition share key diagnostic symptoms with adult-onset schizophrenia (AOS) but his prognoses and comorbidities differ. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by difficulties since early childhood across reciprocal social communication and restricted interests and behaviors. ASD is a lifelong neurodevelopmental disorder, however there is a lack of answers and research for adults with ASD. There are shared aspects of odd thinking, rigid behaviors and impaired socialization in schizophrenia and ASD and COS seems to have a strong relationship with ASD, being comorbid in up to 50% of cases.
Usually the evaluation of the developmental history of the person, prodrome and onset, its course and the presence of positive symptoms of schizophrenia is enough to help us find a diagnosis. Unfortunately, in some ages the conclusion is not so easy to find. However is essential to determine whether the clinical manifestations belong to the autistic spectrum, the schizophrenic or result from comorbidity.
Heart failure (HF) is a worldwide public health problem and the main cause of morbidity and mortality in older people. Previous studies have demonstrated that psychological symptoms are associated with worse cardiovascular outcomes. Nevertheless, the research regarding the association between anxiety and HF is still scarce.
To analyse the levels of anxiety in HF patients and its association with New York Heart Association (NYHA) class in HF patients.
This study takes part of a wider project named Deus Ex-Machina project (NORTE-01-0145-FEDER-00026). HF patients were recruited from an outpatient clinic at a University Hospital. Patient with inability to communicate, with severe visual impairment or with NYHA class IV were excluded. Sociodemographic data and NYHA class were recorded. Anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7).
Overall, 136 patients were included, with a mean age of 57(±13) years old. Most of them were men (66%) and married (76%), with mean education of 8 years (±4). Regarding NYHA class, 36%, 49% and 15% were at class I, II and III, respectively. The mean GAD-7 total score was 6.4 (±5.2) and 32% of patients showed moderate to severe anxiety symptoms. No association between the NYHA functional class and anxiety was found (p=0.106).
The results reveal that anxiety is frequent among HF patients. However, as found in previous studies, it was not associated with more severe HF symptoms. The coexistence of HF and anxiety deserves further studies, in order to build a better understanding of this association.
Antipsychotic drugs are the cornerstone of the pharmacological treatment of psychotic disorders; however, even with Second-generation antipsychotics (SGA), adverse effects continue to be extremely accentuated and the treatment effectiveness is compromised by low adherence of the patient.
Taking into consideration the importance of adverse effects for psychotic therapeutics, this study aims to analyze the adverse effect of the Neuroleptic Malignant Syndrome (NMS) reported in EudraVigilance Database, associated with 3 widely used SGA, Risperidone, Quetiapine, and Clozapine.
The EudraVigilance Database was analyzed from 09/01/2017 to 31/10/2020 about NMS, associated with Risperidone, Quetiapine, and Clozapine. NMS is the second most reported adverse effect inside the Nervous System Disorders SOC (System Organ Class). There were just considered NMS as suspected adverse effect.
It was observed a general tendency of reduction of NMS reports from 2017 to 2020 (most of them performed by healthcare professionals). Risperidone presented the highest level of reports during this period (more than 350), followed by Quetiapine and Clozapine. The NMS reports were predominantly referred to the male sex, from 18 to 64 years old. Risperidone presented the lowest number of fatal cases of NMS (1), in contrast with 3 reported with Quetiapine and Clozapine. A significant number of patients with Schizophrenia recovered from NMS.
It is important to do clinical monitoring of the NMS, because it is rare, although it has life-threatening consequences. Pharmacovigilance databases are important tools to evaluate the safety of drugs and it must be more widely and efficiently promoted for healthcare and patients use.
In Brazil there is high number of children with Intellectual Disability (ID) who begin basic education but did not receive a diagnosis. The basic education teachers can be important agents in identifying signs of ID in the student so that they can be referred to health services.
To develop and implement a decision-making model for basic education teachers to identify students with predictive signs of ID.
The sample was composed by 51 teachers from 20 public schools and their 1758 students eligible for the study enrolled in a educational network in São Paulo state, Brazil. A standardized model was developed for the evaluation process using an open-source software named BONITA. For the screening of students with ID signs the teachers answered a checklist based on the diagnostic criteria of the DSM-5 and the students were evaluated with neuropsychological test WASI (Wechsler Abbreviated Scale of Intelligence) and neuropsychiatric assessment. A Classification Based on Association Rules (CBA) generated the predictive models of sensitivity for confirming ID from the items in the checklists.
35 children had suspected ID. The CBA showed an accuracy of 82%, identifying only 1 false-negative case and 3 false-positive cases for ID. According to the teachers, the most accurate signs were deficits in abstract thinking skills, deficits in communication and conversation and difficulties in emotional regulation in social interactions.
The decision-making model by elementary school teachers to identify students with ID showed high levels of sensitivity and can help the waiting for diagnosis.
To propose a set of internationally harmonized procedures and methods for assessing neurocognitive functions, smell, taste, mental, and psychosocial health, and other factors in adults formally diagnosed with COVID-19 (confirmed as SARS-CoV-2 + WHO definition).
We formed an international and cross-disciplinary NeuroCOVID Neuropsychology Taskforce in April 2020. Seven criteria were used to guide the selection of the recommendations’ methods and procedures: (i) Relevance to all COVID-19 illness stages and longitudinal study design; (ii) Standard, cross-culturally valid or widely available instruments; (iii) Coverage of both direct and indirect causes of COVID-19-associated neurological and psychiatric symptoms; (iv) Control of factors specifically pertinent to COVID-19 that may affect neuropsychological performance; (v) Flexibility of administration (telehealth, computerized, remote/online, face to face); (vi) Harmonization for facilitating international research; (vii) Ease of translation to clinical practice.
The three proposed levels of harmonization include a screening strategy with telehealth option, a medium-size computerized assessment with an online/remote option, and a comprehensive evaluation with flexible administration. The context in which each harmonization level might be used is described. Issues of assessment timelines, guidance for home/remote assessment to support data fidelity and telehealth considerations, cross-cultural adequacy, norms, and impairment definitions are also described.
The proposed recommendations provide rationale and methodological guidance for neuropsychological research studies and clinical assessment in adults with COVID-19. We expect that the use of the recommendations will facilitate data harmonization and global research. Research implementing the recommendations will be crucial to determine their acceptability, usability, and validity.
This study evaluated the effect of roughage:concentrate (R:C) ratio associated with a variable particle size of physically effective neutral detergent fibre (peNDF8) in the forage (Tifton-85 hay) on the performance, carcass traits and meat quality of lambs. Seventy-two 4-month-old, non-castrated Santa Ines male lambs (23.5 ± 2.32 kg BW) were distributed in a completely randomized design, in a 2 × 2 factorial arrangement [two peNDF8 hay particle sizes (13 and 6 mm) and two R:C ratios (700:300 and 500:500 g/kg DM total)]. DMI, DM, NFC and TDN digestibility's, N-intake and N-faecal excretion were affected by the R:C ratio (P < 0.05). However, the N-retained was not affected by the studied variables (P > 0.05). It was observed an interaction (P < 0.05) between the peNDF8 and R:C ratios for final BW, average daily gain (ADG), colour parameters and pH 24 h. The lower roughage ratio provided greater (P < 0.05) concentrations of C14:1, C16:1–cis9, C18:1–cis9, ΣMUFA, Σn–6:Σn–3 and hypocholesterolemic/hypercholesterolemic index, enzymatic activity Δ9desaturase-C16 and -C18. Lambs fed a lower roughage diet had improved performance and feed efficiency, however, presented reduced polyunsaturated fatty acids (PUFA) concentrations in the meat, especially Σn–3 family. Higher roughage diet and larger peNDF8 particle size improved the concentrations of PUFA while decreased Σn–6:Σn–3 ratio in meat. Larger peNDF8 particle size associated with higher roughage proportion, have reduced animal performance however, it increased protein concentration, a* and C* colour parameter without affecting fatty acids profile of Longissimus lumborum muscle.
Despite evidence showing that the intake of ultra-processed food has a negative impact on health, diet quality and dietary vitamin E, its impact on vitamin E nutritional status and breast milk remains unknown. This study aimed to assess the influence of the consumption of ultra-processed foods on vitamin E biomarkers of lactating women. A cross-sectional study was performed with 294 lactating women. Food consumption was obtained by 24-h dietary recall, and foods were grouped according to the NOVA classification. Levels of α-tocopherol were analysed by HPLC. Breast milk vitamin E (BMVE) adequacy was based on the quantity of the vitamin in the estimated intake volume. The Kruskal–Wallis test was used to compare the tertiles and linear regression to association between ultra-processed food consumption and biomarkers. Ultra-processed foods accounted for 16 % of energy intake and vitamin E intakes by all women were considered low. Serum α-tocopherol was 26·55 (sd 7·98) µmol/l, 5 % (n 11) showed inadequate vitamin E (< 12 µmol/l) and 78 % had an inadequate BMVE content (< 4 mg/780 ml). The regression showed that a higher dietary share of ultra-processed foods was associated with lower concentrations of serum α-tocopherol (β = –0·168, 95 % CI –0·047, 0·010, P = 0·003) and inadequate BMVE content (β = –0·144, 95 % CI = –0·505, 0·063, P = 0·012) (adjustment for income and maternal age). Thus, higher dietary shares of ultra-processed foods had an impact on vitamin E biomarkers, suggesting that inadequate dietary intake practices during lactation may reduce the supply of vitamin E to women and breast milk.
A single spray application of a continuously active disinfectant on portable equipment resulted in significant reductions in aerobic colony counts over 7 days and in recovery of Staphylococcus aureus and enterococci: 3 of 93 cultures (3%) versus 11 of 97 (11%) and 20 of 97 (21%) in quaternary ammonium disinfectant and untreated control groups, respectively.
Tympanostomy is one of the most commonly performed surgical procedures in otolaryngology, and its complexity is challenging for trainee surgeons. Investing in medical education is a cornerstone of good patient safety practices. For trainees, use of simulators before operating on actual patients helps mitigate risks. This study aimed to develop a three-dimensional printed model simulator for myringotomy, tympanostomy and ventilation tube placement.
An articulated model with a detachable portion, base and plastic bag to simulate the external auditory canal, middle ear and tympanic membrane, respectively, was modelled and printed.
The final simulator was made from acrylonitrile butadiene styrene polymer and measured 4 × 4 × 12 cm. It was designed to mimic the angulation of patient anatomy in the myringotomy position and simulate the texture and colour of the tissues of interest. The cost was low, and testing with an operating microscope and endoscope yielded satisfactory results. The advent of three-dimensional printing technology has made surgical simulation more accessible and less expensive, providing several advantages for medical education.
The proposed model fulfilled expectations as a safe, inexpensive, reproducible, user-friendly and accessible surgical education tool that can be improved and reassessed for further research.
The retention of human milk (HM) fat in nasogastric probes of infusion pumps can be observed during the feed of infants unable to suck at the mother’s breast. The lack of homogenisation of HM could contribute to the fat holding. Therefore, the present study evaluated (i) the influence of homogenisation on milk fat retaining in infant feeding probes and (ii) the in vivo effect of the homogenisation on lipid absorption by Wistar rats. The animals were fed with HM treated following two processing conditions, that is, pasteurised and homogenised–pasteurised. The animals were randomly subdivided into four experimental groups: water-fed (control), pasteurised milk, homogenised–pasteurised milk and pasteurised–skimmed milk. The results of food consumption, mass body gain, corporate metrics and plasma blood levels of total cholesterol did not show any difference (P < 0·05) among the three types of HM used in the experiments. The liver, intestine and intra-abdominal adipose tissue of the four groups of animals presented normal and healthy histology. The composition of fatty acids in the brain tissue of animals fed with homogenised HM increased when compared with the groups fed with non-homogenised HM. These values were 11·08 % higher for arachidonic acids, 6·59 % for DAH and 47·92 % for nervous acids. The ingestion of homogenised HM promoted higher absorption of milk nutrients. Therefore, the addition of the homogenisation stage in HM processing could be an alternative to reduce fat retention in probes and to improve the lipids’ absorption in the body.
Several sag-type basins apparently developed from rift systems, but there is no consensus about how and if these grabens influenced the sedimentation of the post-rift thermal subsidence phase. The Ediacaran Jaibaras Rift Basin is one of the best-exposed sedimentary records among the NE Brazil late Precambrian – early Cambrian rift system, cropping out at the eastern margin of the intracratonic Parnaíba Basin and extending below it towards the west. Here we present detrital zircon U–Pb ages of rocks from the Jaibaras (Aprazível Formation) and Parnaíba (Ipu Formation) basins, in order to understand the provenance patterns, maximum depositional ages (MDA) and age relationship between these units. The MDA for the Aprazível Formation (c. 499 ± 5 Ma) indicates a Cambrian age for the upper part of the Jaibaras Basin. The bulk U–Pb data indicate that the Ipu Formation started to deposit during late Cambrian and/or Early Ordovician time, despite its MDA (c. 528 ± 11 Ma) being older than that of the Aprazível Formation. Detrital zircon provenance suggests that the primary source areas for the early deposits of the Parnaíba Basin were mountains related to the Brasiliano Orogeny to the south and SE (e.g. Rio Preto and Riacho do Pontal metamorphic belts). Finally, our data emphasize the key change in source areas from the rift to the initial deposition of the intracratonic phase, indicating major depositional style changes between both basins after the Gondwana assembly.