Human Care Research Articles

Wee Nuzzle: A QI Initiative to Promote Nonnutritive Breastfeeding for Preterm Infants.

Nonnutritive breastfeeding (NNBF) benefits preterm infants younger than 34weeks' gestational age (GA), but it is often delayed in those on noninvasive respiratory support. Our primary aim was to reduce the mean number of days to NNBF by 50% in infants born at less than 34weeks' and more than 30weeks' corrected GA within a 12-month period. Our global aim was to increase provision of human milk at discharge. This 1-year quality improvement (QI) initiative involved a multidisciplinary team employing a key driver diagram, fishbone analysis, and "Wee Nuzzle" guidelines, implemented through Plan-Do-Study-Act cycles. The first cycle focused on training health care providers, the second on integrating NNBF into medical progress notes, and the third on incorporating NNBF into the electronic medical record (EMR). Data were collected using EMR and the California Perinatal Quality Care Collaborative database. The initiative achieved its Specific, Measurable, Achievable, Realistic and Time bound (SMART) aim, reducing the mean time to first NNBF by 66%, from 12.0 to 4.1days. Additionally, the global aim of increasing human milk provision at discharge improved from 59% to 72%. This QI initiative effectively reduced the time to first NNBF attempt and increased human milk provision at discharge. Ongoing assessment of human milk exposure post-neonatal intensive care unit discharge is needed.

Examining Daily Living Skills and Economic Hardship for Youth With Disabilities Using the NLTS2012

Daily living skills (DLS) are crucial to the postschool success of all students with disabilities. However, there are discrepancies in the opportunities and supports for the development of DLS for students with intellectual disability and autism. In this pre-registered study, we used data from the National Longitudinal Transition Study 2012 to create a latent construct of DLS and examine its relationship with economic hardship. Results indicated students with intellectual disability and autism had the lowest level of DLS compared with students with high-incidence disabilities. Non-White students faced higher levels of economic hardship compared with White students. Results from this study have implications for large-scale survey design and indicate a need for additional research on students of color with intellectual disability or autism.

Emotions and Experiences of Pregnant Women with a History of Pregnancy Loss: A Qualitative Study Based on Watson’s Theory of Human Caring

Emotions and Experiences of Pregnant Women with a History of Pregnancy Loss: A Qualitative Study Based on Watson’s Theory of Human Caring

Thinking with Amazonian Indigenous Peoples to expand ideas on domestication

Abstract Indigenous knowledges are being increasingly recognized as fundamental for environmental governance, ecosystem management and biodiversity conservation. However, they tend to be recognized by Western science only when they converge with Western scientific knowledge, while ontological differences are generally treated as irrelevant or unreasonable beliefs. Given this scenario, embracing difference as a productive and fundamental aspect to truly understand these epistemologies is crucial to advance fair and symmetrical epistemological dialogues. Current domestication models are key to interpreting human‐plant‐animal‐landscape entanglements. However, they have been criticized in the Amazonian context for remaining steeped in the Western logic of human control over nature and for neglecting local worldviews, which do not assume a dichotomy between nature and culture. In light of this, we propose a thought‐provoking exercise that aims to broaden ideas on domestication as inspired by Indigenous worldviews. We integrate insights derived from Amazonian Indigenous knowledge systems to construct a conceptual model of domestication. We then engage the synthesis resulting from this approach with concepts and theories from ecology and anthropology. In our model, plants, animals, supernatural beings and humans care for, manage and cultivate their domains. Since, according to Indigenous ontologies, all these beings have agency, intentionality, and human qualities, they all share the status of domesticators in our model. The outcome of the combined actions of these beings is an entirely socialized forest, formed by a mosaic of domūs of both humans and non‐humans. Thus, in our model, the forest is fully domesticated by the action of a multiplicity of beings, who possess symmetrical agencies and are constantly interacting socially. By following the reflective path constructed in our approach, we invite the reader to ‘think with’ Indigenous Peoples. Instigated by this framework, we suggest directions to broaden conventional ecological approaches used for studying socio‐ecological systems and promote conservation. We hope to inspire the creativity of current ecological research dynamics to design investigations that go beyond the anthropocentric perspective and the nature/culture dichotomy. Read the free Plain Language Summary for this article on the Journal blog.

Abstract TP376: S-nitrosoglutathione Reduced Ischemia/reperfusion Injury by Relieving Thrombo-inflammation in Experimental Stroke Models

Aims: S-nitrosoglutathione (GSNO) is an endogenous low-molecular-weight S-nitrosothiol, involved in storing and transporting of nitric oxide. The study was aimed to test the effects of GSNO in ischemia/reperfusion (I/R) Injury through relieving thrombo-inflammation. Methods: Male C57BL/6 mice (n=160) were 10-week-old (20-25 g) at the time of surgery. Mice were administered with carboplatin (60 mg/kg body weight) intraperitoneally to build thrombocytopenic models. The animals were randomized and coded by an independent researcher who was not involved in the data analysis. Investigators involved in the surgery and evaluation of all parameters were blinded to the experimental groups. The mice were randomly divided into four groups: 1) regular I/R models with iv. normal saline (NS), 2) regular I/R models + 1 mg/kg iv. GSNO, 3) thrombocytopenic I/R models with iv. NS, and 4) thrombocytopenic I/R models +1 mg/kg iv. GSNO. All animals received humane care in compliance with Beijing Tiantan Hospital’s guidance. Levels of P-selectins, interferon (IFN)-γ and infarct volume and were compared. Results: Mean blood platelets count was 177 10^9/L in the mice administrated with carboplatin, and 383 10^9/L in the mice without carboplatin administration (p < 0.05). Comparing with the mice treated with NS, P-selectin in the ischemic brain tissue were significantly decreased after injected with GSNO either at 24 h (1610.5 vs. 863.0 pg/ml, p < 0.05) or at 7 d (1056.8 vs. 590.0 pg/ml, p < 0.05) in regular mice, and in thrombocytopenic mice (2874.2 vs. 2113.0 pg/ml, p < 0.05, at 24 h） and（3088.0 vs. 2373.0 pg/ml, p < 0.001, at 7 d） (Fig1). After treating with GSNO, levels of IFN-γ were decreased in regular mice (24 h: 635.4 vs. 244.8 pg/ml, p < 0.05; at 7 d: 559.2 vs. 100.0 pg/ml, p <0.05）and thrombocytopenic mice（24h: 423.0 vs. 491.8 pg/ml, p < 0.05; 7d: 319.6 vs. 155.4 pg/ml, p < 0.05）(Fig1). GSNO tended to have the effect of decreasing infarct volume in regular mice（24h: 65% vs. 79%, p = 0.11; 7d: 31% vs. 62%, p = 0.05） and thrombocytopenic mice（24h: 42% vs. 79%, p =0.06; 7d: 60% vs. 62%, p =0.69）than NS (Fig2). Conclusions: GSNO reduced inflammation by limiting platelets activation to protect I/R injury in experimental stroke models.

Detection of Mycoplasma spp. from snakes from five different families

BackgroundMycoplasmas are an important cause of respiratory diseases in tortoises. In snakes, evidence of mycoplasma infections has been found almost exclusively in pythons. To better understand the occurrence of these bacteria in other snake species, samples submitted for routine testing for respiratory pathogens were also tested for mycoplasma by polymerase chain reaction (PCR). A total of 640 samples (mostly oral swabs) from snakes of 5 different families (Boidae n = 114, Colubridae n = 109, Elapidae n = 34, Pythonidae n = 301 and Viperidae n = 82) were included in the study. A genus-specific PCR (PCR1) developed for the detection of Mycoplasma [Mycoplasmopsis] agassizii and a pan-mycoplasma PCR (PCR2) were used. PCR products were sequenced for validation and phylogenetic analysis was performed. The sampled animals were from various owners and collections, all in human care at the time of sampling. Clinical background information was not provided.ResultsUsing PCR1, mycoplasmas were detected in 175 (175/640, 27%) samples (Boidae: 7/114, 6%; Colubridae: 3/109, 3%; Elapidae: 8/34, 24%; Pythonidae: 155/301, 51%; Viperidae: 2/82, 2%). A higher percentage of positive results were obtained using PCR2 (258/640, 40%; Boidae: 9/114, 8%; Colubridae: 25/109, 23%; Elapidae: 19/34, 56%; Pythonidae: 172/301, 57%; Viperidae: 33/82, 40%). The detected bacteria can be divided into at least 6 genetically diverse clusters representing different genera and species based on multiple sequence alignment and phylogenetic analysis.ConclusionsThese results show that diverse mycoplasmas are found in pythons and other snakes. Further investigations are necessary to evaluate the role of various mycoplasmas in respiratory diseases in snakes.

Disseminated nontuberculous mycobacteriosis due to Mycobacterium avium subsp. hominissuis infection in a reindeer from a zoo.

Bacteria in the Mycobacterium tuberculosis complex and nontuberculous mycobacteria may affect a variety of animal species under human care and pose public health risks as zoonotic pathogens. A case of sudden onset of lethargy and increased respiratory effort in a 5-y-old, intact female reindeer (Rangifer tarandus) under managed care had progressed to severe dyspnea despite aggressive treatment. The animal was euthanized due to poor prognosis. Postmortem findings included: disseminated miliary nodules in the lungs, pleura, small intestine, liver, and spleen; enlarged mesenteric lymph nodes; dilated mesenteric and serosal lymphatic vessels; and renal infarcts. Histologically, granulomatous lymphadenitis and lymphangitis with intrahistiocytic acid-fast bacilli were observed. Mycobacterium sp. DNA was detected in lung via real-time PCR. Mycobacterial culture and sequencing identified Mycobacterium avium subsp. hominissuis (MAH) within pulmonary lesions. Infection with MAH has been reported in humans and many animal species; this nontuberculous mycobacterial infection may be an emerging concern in animals under managed care. To our knowledge, MAH infection has not been reported previously in reindeer.

ESTRATÉGIAS DE MANEJO DA DOR NA UNIDADE DE TERAPIA INTENSIVA ADULTA: REVISÃO INTEGRATIVA

Pain in critically ill patients admitted to intensive care units (ICUs) is a frequent and complex experience that can have negative impacts on patient recovery and well-being. Effective pain management through multimodal approaches is essential to ensure quality and humanized care. This study aimed to identify effective pain management strategies for adults in ICUs. This is an integrative review, including studies that addressed pain management strategies in critically ill patients. The search was conducted in the National Library of Medicine (PubMed), Web of Science (WOS), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American and Caribbean Literature in Health Sciences (LILACS) databases, via the Virtual Health Library (VHL). The selection resulted in 1266 studies, of which 9 met the inclusion criteria, among them, revisional studies, including systematic reviews, meta-analysis and integrative reviews, as well as clinical trials and cohort studies. It is concluded that this review reinforces the importance of a multidisciplinary approach in this management, where the combination of drugs and non-pharmacological techniques proves to be fundamental to meet the individualized needs of each patient and promote effective pain control.

Fecal microbiota is more stable during degradation and more diverse for ex situ cheetahs in Namibia compared to the USA

The relationships between gut microbiota and animal health are an important consideration increasingly influential in the management of wild and ex situ endangered species, such as the cheetah (Acinonyx jubatus). To better understand these relationships, fresh fecal samples are currently required as a non-invasive alternative for the gut microbiome. Unfortunately, fresh samples are challenging to collect in the wild. This study had two aims: 1) to determine the optimal collection time point for cheetah feces after deposit in their native environment of Namibia as a guide for wild cheetah fecal microbiome studies; and 2) to compare the fecal microbiota of two ex situ cheetah populations (Front Royal, VA, USA and Otjiwarongo, Namibia), which also consume different diets. We collected eight fresh fecal samples from cheetahs in Namibia and allowed them to decompose for four days, taking subsamples each day. The fresh Namibian samples (n = 8) were also used in objective two for comparison to fresh USA cheetah samples (n = 8). All samples were analyzed for bacterial community diversity and composition using 16S rRNA gene amplicon sequencing. First, over a five-day sampling period in Namibia, subsamples 1-3 days post-fresh showed no changes in bacterial diversity or composition compared to fresh subsamples. Second, fresh ex situ cheetah samples under Namibian conditions had increased bacterial taxa, more phylogenetically diverse bacterial communities, and compositionally distinct microbiomes from cheetahs managed in human care in the USA. However, when bacterial ASVs were weighted by relative abundance, both populations shared 69% of their total bacterial sequences indicating a conserved cheetah microbiota between the two populations. We also found few differences in predictive functions of the fecal microbiota between the populations, where only one disease-related pathway was higher in the USA samples. Overall, our findings suggest that in dry season conditions (no recorded rainfall) in Namibia, fecals may be usable for up to three days after defecation for microbial ecology studies. There are significant differences between ex situ Namibian and USA populations, and we suggest further investigation into the influence of diet, host demographics, and environment on the gut microbiota and health of cheetahs.

Understanding the perspectives of police officers regarding men who use drugs and drug rehabilitation in China: a qualitative study

ABSTRACT Background: Drug use among men is a significant public health concern in China, with compulsory drug treatment centers being the primary approach. Police officers in these centers play a crucial role in shaping the interactions and experiences of men who use drugs (MWUD). However, little research exists on the attitudes of police officers toward MWUD in China. Objectives: This qualitative study aimed to explore the attitudes of police officers toward MWUD and drug rehabilitation approaches in China. Methods: Semi-structured individual interviews were conducted among 23 police officers recruited from two compulsory drug treatment centers in Jiangsu Province, China. Of the participants, two were females and 21 were males. Thematic analysis was employed to analyze the data. Results: Three key themes emerged: 1) Multifaceted perspectives on MWUD. Participants viewed MWUD as offenders, victims, and patients. 2) Dynamic interactions with MWUD. Relationships were characterized as either adversarial or supportive, influenced by participants’ personalities, experiences, beliefs, workload, and psychological training. 3) Advocating for punitive measures in drug rehabilitation. While the participants generally favored strict penalties for MWUD, they acknowledged the value of community-based rehabilitation. Concerns about social stigma, privacy, motivation, and the costs of voluntary rehabilitation tempered their support. Conclusions: The study highlights the importance of raising awareness and challenging bias among police officers. It emphasizes the need for psychological training to enhance their capacity to provide humane care and foster positive interactions with MWUD. Additionally, ensuring access to affordable, accessible, and stigma-free voluntary rehabilitation is crucial for effective drug rehabilitation efforts.

The application of mind mapping in the standardized education of inpatient physicians in nephrology

This study aims to investigate the effectiveness of mind mapping in the standardized training and education of internal medicine resident physicians in nephrology. Sixty trainees undergoing rotations in the Nephrology Department at Chengdu University Affiliated Hospital between January 2021 and December 2023 were randomly assigned to control and observation groups, each comprising 30 trainees. The observation group received mind mapping teaching, while the control group received traditional teaching methods. The clinical thinking training of the two groups was then compared. The observation group outperformed the control group in all aspects of the Mini-CEX assessment, including medical interviews, humanistic care, clinical judgment, communication skills, overall performance, and total score, with statistical significance (P < 0.05). However, there were no statistically significant differences between the two groups in the areas of physical examination and organizational effectiveness (P > 0.05). Furthermore, the observation group achieved higher scores than the control group in the final theory exam, skill exam results, and satisfaction, with statistically significant differences (P < 0.05). Mind mapping not only aids in the consolidation of fundamental memorized knowledge but also enhances clinical thinking skills, thereby playing a pivotal role in assisting resident physicians in establishing a comprehensive knowledge base in nephrology and improving the effectiveness of their training.

Palliative Care Spiritual Assessment and Goals-of-Care Discussions in the Neurocritical Care Unit: Collaborating with Chaplains.

Neuropalliative care is an emerging subspecialty of palliative care designed to address the unique supportive care needs of patients with serious neurological illness, including those receiving neurocritical care in intensive care units. Spiritual care is a vital component in the provision of holistic and humanized care to these patients. A chaplain who is specially trained and credentialed in care for those with serious illness is the health care professional responsible for making spiritual assessments and contributes to the plan of care, facilitating decision making, and guiding other clinicians in the provision of generalist spiritual care. This article illustrates the role of chaplains in supporting neurocritical care patients and highlights two fundamental aspects of spiritual care: (1) spiritual screening/assessment and (2) assistance with goals-of-care conversations. These cases clarify the role of professionally trained and credentialed chaplains with experience in both neurocritical and palliative care and the value added to the interprofessional team.

Amino acid profiles for red wolves (Canis rufus) managed under human care are significantly different compared to the profiles of domestic dogs (Canis familiaris).

To establish a reference interval for amino acid profiles for healthy red wolves (Canis rufus). Heparinized plasma of 48 red wolves was collected between August 2023 and April 2024 and sent to the University of California-Davis Amino Acid Laboratory for analysis. Reference intervals were created using the published American Society for Veterinary Clinical Pathology reference interval guidelines. Data were analyzed via Gaussian data distribution, and parametric statistical methods were used to produce a 90% CI of reference limits. The means of the red wolf intervals created were compared to those of the domestic dog using a z test. Reference intervals were created for red wolves (n = 48). Upon completion of the z test, 11 of 21 amino acids were found to be statistically significantly different compared to those of the domestic dog. A reference interval was created for red wolves. The red wolf amino acid profiles are different than those of the domestic dog, with 52% (11/21) of the profiles being statistically different. Red wolf amino acid profiles should not be compared to those of the domestic dog reference intervals due to the significant difference between profiles.

Repercussions of the Interruption of a Community Choir in face of the COVID-19 Pandemic

Introduction: Music used as a tool in health care can be a powerful resource for humanized care in mental health. However, the interruption of groups due to the coronavirus pandemic brought challenges to public health practices. The aim of the study was to analyze the repercussions of the interruption of a community choir on the promotion of mental health in users of the Psychosocial Care Network. Network. Methods: With a qualitative approach, an intentional sample was carried out with all members of the community choir. Eight of the 12 members participated in semi-structured interviews, with the data submitted to thematic content analysis. Results: This article focuses on the thematic categories “Impacts of the COVID-19 pandemic on the interruption of the choir” and “Social distancing imposed by the COVID-19 pandemic: difficulties and suggestions”. Discussions: Repercussions of the dismantling of the group on the lives and mental health of the participants were discussed. Suggestions for alternative activities during distancing were also addressed. Deprivation aroused fantasies associated with death, freedom, bonds and feelings of emptiness and lack of motivation. There were also suggestions for activities involving Information and Communication Technology.

The Effect of an Improved Environment According to Watson's Theory of Human Care on Sleep, Anxiety, and Depression in Patients Undergoing Open Heart Surgery: A Randomized Controlled Trial.

Background/Objectives: According to Watson's Human Care Theory, an improved environment influences patients' care processes. The purpose of this study was to examine the effect of an improved environment, according to Watson's Human Care Theory, on sleep quality, anxiety, and depression in patients undergoing open heart surgery. Methods: Upon admission to the ward from the postoperative intensive care unit, the experimental group underwent environmental remediation for three days. The environmental arrangements ensured that the patient's room maintained an appropriate temperature range of 18-26 °C and humidity values of 30-50%. Monitoring took place at 21:00, 22:00, and 23:00 on Days 1, 2, and 3, at which times, the brightness of the patient rooms gradually decreased. On the morning of the fourth day, the patients were interviewed face to face, and research questionnaires were filled out (ClinicalTrials.gov identifier of the manuscript: NCT06744023). Results: After the implementation of an improved environment in accordance with Watson's Human Care Theory, the sleep duration of the patients in the experimental group (5.91 h) was higher than that of the control group (4.1 h). At the same time, the mean sleep quality score was measured as 300 ± 15.33 in the experimental group and 116.33 ± 14.94 in the control group. In addition, anxiety and depression levels were lower in the experimental group (5.63 ± 0.59; 4.53 ± 0.42) compared with the control group (12.03 ± 0.85; 10.03 ± 0.82). Conclusions: We recommend implementing improved environmental arrangements in accordance with Watson's Human Care Theory to improve sleep quality and reduce anxiety and depression levels in patients undergoing open heart surgery.

Assessing the Efficacy of ChatGPT Prompting Strategies in Enhancing Thyroid Cancer Patient Education: A Prospective Study.

With the rise of AI platforms, patients increasingly use them for information, relying on advanced language models like ChatGPT for answers and advice. However, the effectiveness of ChatGPT in educating thyroid cancer patients remains unclear. We designed 50 questions covering key areas of thyroid cancer management and generated corresponding responses under four different prompt strategies. These answers were evaluated based on four dimensions: accuracy, comprehensiveness, human care, and satisfaction. Additionally, the readability of the responses was assessed using the Flesch-Kincaid grade level, Gunning Fog Index, Simple Measure of Gobbledygook, and Fry readability score. We also statistically analyzed the references in the responses generated by ChatGPT. The type of prompt significantly influences the quality of ChatGPT's responses. Notably, the "statistics and references" prompt yields the highest quality outcomes. Prompts tailored to a "6th-grade level" generated the most easily understandable text, whereas responses without specific prompts were the most complex. Additionally, the "statistics and references" prompt produced the longest responses while the "6th-grade level" prompt resulted in the shortest. Notably, 87.84% of citations referenced published medical literature, but 12.82% contained misinformation or errors. ChatGPT demonstrates considerable potential for enhancing the readability and quality of thyroid cancer patient education materials. By adjusting prompt strategies, ChatGPT can generate responses that cater to diverse patient needs, improving their understanding and management of the disease. However, AI-generated content must be carefully supervised to ensure that the information it provides is accurate.

Perceived satisfaction and humanized nursing care in surgical patients public hospital of Peru.

Humanized care is the first aspect to consider to satisfy the surgical patient who will be or has undergone a surgical intervention. Determine the relationship that exists between perceived satisfaction and humanized nursing care in surgical patients in a public hospital in Peru. Descriptive, observational, correlational study, with a quantitative approach, with probabilistic sampling of 241 surgical patients. A validated questionnaire adapted to our reality was used, reporting a Cronbach Alpha coefficient of 0.890 (satisfaction) and 0.904 (humanized nursing care), presenting 36 multiple choice questions. The age group of 18-29 years predominated in 26.6% (n = 64), with the average age X = 42.6 years with a DS of 14.47, female sex with 55.2% (n = 133), single marital status 48.5% (n = 117) and secondary education level was 60.2% (n = 145). The majority of patients were satisfied with the care received, reporting 84.6% (n = 204), also found in the dimensions: Humane 81.8% (n = 197), timely 78.8% (n = 190) and safe 80.1% (n = 193). The perceived humanized nursing care was good 81.3% (n = 196), it was also evident in the dimensions: Phenomenological 78.4% (n = 189), interaction 75.9% (n = 183), scientific 61, 8% (n = 149) and human needs (82.2%) (n = 198). A moderate correlation was found between the variables, behaving in a moderately positive manner, that is, the higher the level of satisfaction, the higher the level of humanized nursing care in the surgical patient, and vice versa.

Cetacean Sanctuaries: Do They Guarantee Better Welfare?

The SEA LIFE Trust Beluga Whale Sanctuary (BWS) has been in operation for over five years and serves as a unique case study to evaluate the effectiveness of marine sanctuaries for cetaceans. While cetacean sanctuaries are often regarded as a middle-ground solution between captivity and release, evidence from the BWS highlights complexities in adapting cetaceans to these environments. Despite initial assumptions that natural conditions would inherently improve welfare, the belugas at the BWS spent the majority of the operational period (92.6%) in a conventional indoor pool, due to health and welfare concerns. Repeated delays, challenges in acclimatization, and distress-related conditions observed during periods in the bay suggest that natural environments alone may not guarantee improved welfare. Additionally, the lack of publicly accessible data on health and welfare outcomes hinders comprehensive evaluation of the sanctuary’s success and raises questions about transparency and evidence-based practices. This review underscores the need for refined sanctuary models, improved infrastructure, and structured adaptation programs tailored to species and individual cetaceans. It highlights the importance of robust planning, ongoing research, and transparency to meet the ambitious goals of marine sanctuaries in the best interests of the well-being of cetaceans under human care. These considerations also raise concerns about the decision to relocate captive cetaceans to marine sanctuaries, as the available evidence suggests that such environments may not inherently guarantee better welfare outcomes.

Cutaneous disorders in captive psittacines, a retrospective study of 1454 cases at a university veterinary teaching hospital (1988-2021).

Psittacines (parrots and their allies) are kept under human care as companion animals, live exhibit specimens in zoological institutions and occasionally as research subjects. Cutaneous disorders such as feather destructive behaviour (FDB) and pododermatitis are commonly noted in clinical reviews, case reports and text book chapters. To document the type, signalment associations and prevalence of cutaneous disorders in a large number of captive psittacines in an academic referral teaching hospital population. Case population at a university veterinary teaching hospital. Retrospective study using computerised medical records of birds (psittacine and non-psittacine) examined between 1 January 1988 and 31 December 2021. Inclusion criteria were records of psittacines with dermatological diagnoses. Of 3472 psittacines, 1454 (41.9%) had cutaneous disease. Age was strongly associated with an increased risk of cutaneous diseases. The most common cutaneous disorders were pododermatitis (n = 729) and FDB (n = 528). Female sex and increased age were associated with significantly higher odds of FDB, as were the genera Cacatua (cockatoos), Psittacus (African grey parrots), Ara (macaws) and Agapornis (lovebirds). Increased age and the genus Agapornis also were associated with significantly higher odds of pododermatitis. The most common infectious disease was mite (presumed Knemidocoptes) infestation, almost exclusively seen in budgerigars; increased age was associated with significantly lower odds of having mites. Pododermatitis and FDB were the most common cutaneous disorders in psittacines. As 50% of psittacines with skin disease presented for nonskin concerns, clinicians should perform a dermatological examination regardless of the reason for presentation.

Comprehensive Care and Challenges of Alzheimer's Disease

Introduction: Alzheimer's disease (AD), described by Alois Alzheimer, constituted the most prevalent type of dementia, accounting for 60% to 70% of global cases. This progressive neurodegenerative disorder affected higher cognitive functions such as memory, language and reasoning, causing a gradual loss of autonomy. Its prevalence doubled with age, especially in those over 65 years of age. AD had a significant impact on the quality of life of patients and their caregivers, posing increasing challenges for healthcare systems.Development: AD was characterized by progressive cognitive, physical and social deterioration, with stages ranging from pre-dementia to severe dementia. In its advanced stages, patients became completely dependent and vulnerable to complications such as pressure ulcers and infections. Comprehensive care strategies highlighted the need for multidimensional approaches, encompassing physical, psychological and social interventions. Caregivers, mostly family members, faced a significant emotional burden, which highlighted the importance of providing them with support. For their part, multidisciplinary health teams, led by trained nursing professionals, played a crucial role in disease management.Conclusions: AD demanded a comprehensive approach focused on improving the quality of life of the patient and their caregivers. Although there was no cure, interventions focused on quality of life and humanized care were essential. Research and public policies continued to be fundamental to address the growing impact of this disease on society