The Organization of Home Palliative Cancer Care by Primary Health Care: A Systematic Review Protocol

Greater longevity and chronic diseases, such as cancer, require (re)organization of care for the sustainability of health systems and better quality of life. Palliative care organized by primary health care has positive outcomes, changing standards of care at the end of life, reducing hospitalizations and health costs and contributing to people's autonomy to stay at home with controlled symptoms. However, in many countries, this is not possible because the provision of palliative cancer care is isolated or generalized, concentrated in the hospital, and without the strategic participation of primary care. In many developed countries, where palliative care is offered in an integrated way, home care has increased the people's chances of receiving dignified care at the end of life. The aim of this review is to evaluate the organization of home palliative cancer care by primary care to improve the use of health resources and the quality of life of such patients. This systematic review protocol follows the Cochrane methodology to provide a narrative synthesis, with the resulting report guided by the Preferred Reporting Items for Systematic Reviews (PRISMA).

A Qualitative Study of the Limits and Possibilities of Integrating Palliative Care in Heart Failure

Heart failure is a progressive condition with a high burden of symptoms and clinical decompensations that causes psychological and social suffering, poor quality of life, and limited life expectancy. Therefore, it requires palliative care to control symptoms and signs, but integrating it with clinical care is complicated. We aimed to discuss the limits and possibilities of integrating palliative care in heart failure. This was a qualitative descriptive study. Semi-structured qualitative interviews were carried out between July 2020 and July 2021. We applied the thematic content analysis and the SWOT matrix. Ethical principles were respected. Ten professionals from an Institute specializing in cardiovascular diseases in Rio de Janeiro, Brazil, participated in the study, including physicians, nurses, psychologist, and occupational therapist. We identified 4 categories related to intervening factors: the patient's profile, the emotional aspects of professionals facing these patients, the challenges to integrating and sustaining palliative care in practice, and the ways for assistance planning in this context. The existence of a specialized team, the palliative care commission, and the institutional palliative care protocol, aligned with the realistic perception of the assistance, organizational, political, and social problems, may promote the advancement of palliative care in heart failure.

Antineoplastic therapy administration: Nursing intervention in the relief of suffering

ABSTRACT Objective: To identify the nursing interventions with potential to act on the suffering and to evaluate the results of the nursing intervention designed. Method: We used a multi method study. After the identification of the scientific evidence and having found the supporting theory, the intervention process to relieve the suffering of hospitalized patients was modeled using the methodology of qualitative research. Then, training conditions were created for the implementation of the intervention Chemotherapy Administration as an Individualized Nursing Intervention, with a Quasi Experimental, longitudinal piloting study. Results: The patients of the experimental group showed values of suffering lower than the control group . Having finished the pilot study, we would return to qualitative research to understand the variation of some data. Final Considerations: The use of mixed methods of investigations allowed the understanding of the different components of drug chemotherapy administration as an individualized nursing intervention.

Quantification and mapping of urban fluxes under climate change: Application of WRF-SUEWS model to Greater Porto area (Portugal)

Climate change and the growth of urban populations are two of the main challenges facing Europe today. These issues are linked as climate change results in serious challenges for cities. Recent attention has focused on how urban surface-atmosphere exchanges of heat and water will be affected by climate change and the implications for urban planning and sustainability. In this study energy fluxes for Greater Porto area, Portugal, were estimated and the influence of the projected climate change evaluated. To accomplish this, the Weather Research and Forecasting Model (WRF) and the Surface Urban Energy and Water Balance Scheme (SUEWS) were applied for two climatological scenarios: a present (or reference, 1986-2005) scenario and a future scenario (2046-2065), in this case the Representative Concentration Pathway RCP8.5, which reflects the worst set of expectations (with the most onerous impacts). The results show that for the future climate conditions, the incoming shortwave radiation will increase by around 10%, the sensible heat flux around 40% and the net storage heat flux around 35%. In contrast, the latent heat flux will decrease about 20%. The changes in the magnitude of the different fluxes result in an increase of the net all-wave radiation by 15%. The implications of the changes of the energy balance on the meteorological variables are discussed, particularly in terms of temperature and precipitation.

A cost-efficiency and health benefit approach to improve urban air quality

When ambient air quality standards established in the EU Directive 2008/50/EC are exceeded, Member States are obliged to develop and implement Air Quality Plans (AQP) to improve air quality and health. Notwithstanding the achievements in emission reductions and air quality improvement, additional efforts need to be undertaken to improve air quality in a sustainable way - i.e. through a cost-efficiency approach. This work was developed in the scope of the recently concluded MAPLIA project "Moving from Air Pollution to Local Integrated Assessment", and focuses on the definition and assessment of emission abatement measures and their associated costs, air quality and health impacts and benefits by means of air quality modelling tools, health impact functions and cost-efficiency analysis. The MAPLIA system was applied to the Grande Porto urban area (Portugal), addressing PM10 and NOx as the most important pollutants in the region. Four different measures to reduce PM10 and NOx emissions were defined and characterized in terms of emissions and implementation costs, and combined into 15 emission scenarios, simulated by the TAPM air quality modelling tool. Air pollutant concentration fields were then used to estimate health benefits in terms of avoided costs (external costs), using dose-response health impact functions. Results revealed that, among the 15 scenarios analysed, the scenario including all 4 measures lead to a total net benefit of 0.3M€·y(-1). The largest net benefit is obtained for the scenario considering the conversion of 50% of open fire places into heat recovery wood stoves. Although the implementation costs of this measure are high, the benefits outweigh the costs. Research outcomes confirm that the MAPLIA system is useful for policy decision support on air quality improvement strategies, and could be applied to other urban areas where AQP need to be implemented and monitored.

Influence of urban resilience measures in the magnitude and behaviour of energy fluxes in the city of Porto (Portugal) under a climate change scenario

Different urban resilience measures, such as the increase of urban green areas and the application of white roofs, were evaluated with the WRF-SUEWS modelling system. The case study consists of five heat waves occurring in Porto (Portugal) urban area in a future climate scenario. Meteorological forcing and boundary data were downscaled for Porto urban area from the CMIP5 earth system model MPI-ESM, for the Representative Concentration Pathway RCP8.5 scenario. The influence of different resilience measures on the energy balance components was quantified and compared between each other. Results show that the inclusion of green urban areas increases the evaporation and the availability of surface moisture, redirecting the energy to the form of latent heat flux (maximum increase of +200Wm(-2)) rather than to sensible heat. The application of white roofs increases the solar radiation reflection, due to the higher albedo of such surfaces, reducing both sensible and storage heat flux (maximum reductions of -62.8 and -35Wm(-2), respectively). The conjugations of the individual benefits related to each resilience measure shows that this measure is the most effective one in terms of improving the thermal comfort of the urban population, particularly due to the reduction of both sensible and storage heat flux. The obtained results contribute to the knowledge of the surface-atmosphere exchanges and can be of great importance for stakeholders and decision-makers.

Impact of forest biomass residues to the energy supply chain on regional air quality

The increase of the share of renewable energy in Portugal can be met from different sources, of which forest biomass residues (FBR) can play a main role. Taking into account the demand for information about the strategy of FBR to energy, and its implications on the Portuguese climate policy, the impact of energy conversion of FBR on air quality is evaluated. Three emission scenarios were defined and a numerical air quality model was selected to perform this evaluation. The results reveal that the biomass thermal plants contribute to an increment of the pollutant concentrations in the atmosphere, however restricted to the surrounding areas of the thermal plants, and most significant for NO₂ and O₃.

Common mental disorders in pregnancy in the context of interpartner violence

Pregnancy is generally described as a period with a high incidence of common mental disorders (CMD) in the life cycle of many women who incur the risk of developing mental problems including depression, post-traumatic stress and drug abuse. Our objective with this study was to gauge how the presence of violence in Portuguese pregnant women affected their psychopathology. One hundred and eighty-four pregnant outpatients of the Obstetrics and Gynaecology Department of the Hospital Pedro Hispano in Matosinhos, Oporto, Portugal with an average age of 29 and in their last 3 months of pregnancy were the subjects of this study. These participants were divided into two groups: one of abused women (n= 107) and another of non-abused women (n= 77). In order to be able to compare them, both groups were assessed with the Conflict Tactic Scale 2, the Brief Symptom Inventory and the Inventory of the Clinical Evaluation of Depression. It was observed that pregnant women who had suffered violence during pregnancy exhibited some form of CMD during pregnancy. Another important finding was the evidence of the negative impacts that domestic violence had on the mental health of women.

Impact of forest fires on particulate matter and ozone levels during the 2003, 2004 and 2005 fire seasons in Portugal

The main purpose of this work is to estimate the impact of forest fires on air pollution applying the LOTOS-EUROS air quality modeling system in Portugal for three consecutive years, 2003-2005. Forest fire emissions have been included in the modeling system through the development of a numerical module, which takes into account the most suitable parameters for Portuguese forest fire characteristics and the burnt area by large forest fires. To better evaluate the influence of forest fires on air quality the LOTOS-EUROS system has been applied with and without forest fire emissions. Hourly concentration results have been compared to measure data at several monitoring locations with better modeling quality parameters when forest fire emissions were considered. Moreover, hourly estimates, with and without fire emissions, can reach differences in the order of 20%, showing the importance and the influence of this type of emissions on air quality.

[Urinary tract infections. The causative agents and their sensitivities to chemotherapeutic drugs]

A retrospective study was made of the requests for bacteriological examination of urine samples by the different clinical departments of Vila Nova de Famalicão District Hospital, between July/89-June/90 and July/91-June/92. We were interested in assessing the spectrum of occurring micro-organisms in urinary tract infections, their antibiotic susceptibility, especially to those more frequently used in clinical practice in this institution and their evolution in time. In conclusion, the prevalence of isolated pathogens was quite similar to the spectrum published by other authors for a hospital population. No significant variation was found in the bacterial population between the two periods analysed, if we exclude the great increase in coagulase-negative staphylococci. In terms of benefits/costs/resistance, we concluded that the best antibiotic for the beginning of therapy in this Hospital is cotrimoxazole. Good choices were also quinolones, third-generation cephalosporins or aminoglycosides, but with the disadvantages of greater cost for the first two and toxicity for the last.