Percorrer por autor "Pires, Sara"
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- Age-related decline in intestinal villus length : a cross-sectional study on the human gutPublication . Vara-Luiz, Francisco; Palma, Carolina; Mendes, Ivo; Piçarra, Francisco; Teles, Ana Elisa; Nogueira, Filipe; Costa-Santos, Inês; Nunes, Gonçalo; Patita, Marta; Mocanu, Irina; Pires, Sara; Meira, Tânia; Vieira, Ana; Pinto-Marques, Pedro; Mascarenhas, Paulo; Leskiv, Iryna; Gomes-Pinto, Daniel; Fonseca, JorgeBackground/Objectives: There is widespread agreement that age is a significant predictor of impaired response to nutritional support. This is generally attributed to anabolic resistance, with impaired absorption considered irrelevant/non-existent. However, animal models demonstrate age-related structural changes in the intestinal mucosa that may reduce absorptive capacity. We aimed to evaluate potential histological changes in the duodenal mucosa associated with aging. Methods: We conducted a single-center observational cross-sectional study. Ambulatory younger (18–45 years) and older (≥70 years) adults referred for upper endoscopy were included and underwent duodenal biopsies. Those biopsies were analyzed and compared for histological/histomorphometric changes, including villus length. Clinical and laboratory data were also recorded. Results: One hundred patients were included (46 men/54 women), 50 aged 18–45 years and 50 aged ≥70 years. There were no duodenal endoscopic changes. The median villus length was 0.35 mm (IQR 0.32–0.41 mm) in older people, lower than in younger adults (0.57 mm; IQR 0.47–0.68 mm) (p < 0.001). In a multivariable regression model including age, sex, and Charlson comorbidity index, age remained inversely associated with villus length (p < 0.001). Older participants also exhibited lower hemoglobin, iron, folate, vitamin B12, albumin and vitamin D levels, despite normal inflammatory markers. Conclusions: Aging is associated with histological changes in the intestinal mucosa, including villus shortening. These findings support the concept of mucosal aging as a distinct biological process. Villus shortening may reflect reduced absorptive surface area and could contribute to age-related nutritional vulnerability, although its functional implications remain to be determined.
- Clinical, endoscopic and histologic differences in gastric mucosa between younger and older adults : an observational study on the aging stomachPublication . Vara-Luiz, Francisco; Mendes, Ivo; Palma, Carolina; Mascarenhas, Paulo; Teles, Ana Elisa; Santos, Inês Costa; Nunes, Gonçalo; Patita, Marta; Mocanu, Irina; Pires, Sara; Meira, Tânia; Vieira, Ana; Pinto-Marques, Pedro; Gomes-Pinto, Daniel; Fonseca, JorgeBackground/Objectives: Age-related changes in the gastric mucosa remain incompletely understood. We aimed to assess and compare clinical, endoscopic and histologic changes in the gastric mucosa associated with aging, and to explore whether gastric aging is associated with a distinct histological pattern. Methods: Single-center observational study. Younger (18–45 years) and older (≥70 years) adults undergoing elective upper endoscopy were included and underwent gastric biopsies. The clinical, endoscopic and histologic features were analyzed and compared. Results: A total of 100 patients were included (45 men/55 women), 50 with 18–45 years and 50 with ≥70 years. Dyspepsia, gastro-esophageal reflux disease and peptic ulcer disease were the most common indications for upper endoscopy. Gastric lesions (erythema, erosions, ulceration and polyps) were more common in older patients (80% vs. 50%, p = 0.003), as well as histologic changes such as chronic gastritis (56% vs. 38%, p = 0.004), chronic atrophic gastritis (CAG; 28% vs. 4%, p < 0.001) and intestinal metaplasia (28% vs. 4%, p < 0.001). These findings persisted after adjusting for Helicobacter pylori (H. pylori) status and proton pump inhibitor intake on the multivariate analysis. Prevalence of H. pylori was similar between both groups (28% vs. 32%, p = 0.189). Conclusions: Aging is associated with clinical, endoscopic and histologic changes in the gastric mucosa including CAG and metaplasia, independent of the presence of H. pylori. These findings may result from several aging-related pathophysiological processes and decades of cumulative gastric injury and support the hypothesis of an aging stomach phenotype, underscoring the need for an age-adjusted interpretation of gastric biopsies.
- A Cross-Sectional Study of the Perception of Individualized Nursing Care Among Nurses in Acute Medical and Perioperative SettingsPublication . Ramos, Ana; Pires, Sara; Sá, Eunice; Gomes, Idalina; Alves, Elisabete; Fonseca, César; Coelho, Anabela; Coelho, AnabelaIndividualized nursing care allows for systematic assessment and intervention; considers a patient’s preferences, values, and context; and contributes to a positive care trajectory. However, its operationalization has proven to be challenging. This research aimed to evaluate nurses’ perceptions of individualized care and analyze their relationship with sociodemographic variables. Methods: A cross-sectional study was conducted on 122 eligible and registered nurses at a Hospital Center, in the Ophthalmology (operating room and inpatient ward) service, the Cardiology service, the Internal Medicine service, and the Medical Emergency Unit, for adults/older adults in Portugal. The nursing version of the Individualized Care Scale (ICS-Nurse) was used for the assessment, including three sub-dimensions: clinical situation, personal life situation, and decisional control over care-related decisions. Cronbach’s alpha and principal component analysis were used for the data analysis. The STROBE checklist was used to report this study. Results: No statistically significant differences were found based on the age, gender, level of education, or years of professional experience of the nurses within the sub-dimensions of individualization. The nurses overall had a good perception of the importance of individualized care (4.06 ± 0.46 ICS-A-NURSE) but faced difficulties in its implementation during the last shift they worked (3.97 ± 0.49 ICS-B-NURSE). Conclusions: The items considered to be of greatest importance were the response to the physical and emotional needs arising from illness and assistance in decision-making through educational instructions. Aspects related to the personal lives of patients, such as family inclusion in an individual’s care plan, everyday habits, and previous experiences of hospitalization, received the lowest scores. Recognizing priority areas for improvement in the individualization of nursing care can contribute to developing training programs and policies that promote a holistic approach. Future studies should consider patient outcomes related to their needs for individualization.
- Technological nursing interventions on nutritional status of middle-aged and older adults undergoing hemodialysis: A systematic reviewPublication . Pernas, Amélia; Pires, Sara; Gomes, Idalina; Fonseca, César; Ramos, AnaObjective: Malnutrition is common in hemodialysis patients, increasing mortality and significantly impacting quality of life. This study aimed to identify technological nursing interventions that promote self-care and improve the nutritional status of middle-aged and older adults undergoing hemodialysis. Methods: A systematic literature review was conducted in accordance with the Joanna Briggs Institute (JBI) and PRISMA guidelines. Searches were conducted in Medline, CINAHL, the Cochrane Library, Scopus, Web of Science, and grey literature. Studies published between 2018 and 2024, involving patients aged 40 years or more undergoing regular hemodialysis, and available in Portuguese, English, or Spanish, were included. JBI's critical appraisal tools were used to conduct a rigorous analysis and methodological quality assessment of the articles. Results: Out of a total of 738 articles, 10 were included for analysis. Five key dimensions of technology-driven self-care interventions were established. 1) Mobile applications and digital platforms with features like nutritional databases, food logging, and personalized feedback; 2) E-learning and virtual education using social media and chat-based communication; 3) Telenursing employing a hybrid follow-up model of face-to-face, telephone, and SMS contact; 4) Educational strategies focused on nutritional status, utilizing methods such as teach-back and pictorial learning within a multidisciplinary team; and 5) Comprehensive assessment tools evaluating treatment adherence (hemodialysis, medication, diet, fluid) and laboratory markers. Significant improvements were reported across several outcomes: eight studies showed enhanced biochemical markers (e.g., phosphorus, sodium, potassium, calcium, iron, albumin, urea, and hemoglobin) and nutritional status, three demonstrated increased self-efficacy, and two reported improved quality of life. Conclusion: Integrating technology and face-to-face education enhances nutritional status, highlighting the importance of comprehensive strategies to improve treatment adherence and prevent malnutrition in hemodialysis patients.