A Systematic Literature Review

Social prescribing (SP) is an approach that promotes the use of local non-clinical activities by people. The referral is usually made by primary health-care professionals, in a process wherein local providers play a pivotal role. The main objective of this study was to identify domains of intervention and evidence about the effectiveness of SP programs regarding health-related outcomes. A systematic literature review was carried out following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was conducted in PubMed, CINHAL, and SCOPUS. Inclusion criteria of the reviewed papers were as follows: (i) effectiveness studies of interventions designated as SP or interventions entailing SP conceptual components; (ii) interventions with adults. Quality assessment was performed with the Cochrane tool for assessing risk of bias in randomized trials; an assessment tool developed by the US National Heart, Lung and Blood Institute was applied to observational studies. Overall, 13 articles were included for analysis, with a total of 4603 patients. Although three studies comprised a control group, only two followed a randomized controlled trials (RCT) design. Nine principal domains of intervention within SP were identified, with three categories of outcome measures: Physical and psychological wellbeing; Health behaviors and self-efficacy; and Health care resources end economic evaluation. SP is an emergent and promising health-care intervention, and it has been used to promote different health behaviors. Evidence of SP effectiveness on patient’s health and wellbeing is not strong. Further research is needed for understanding how SP can be applied efficiently.info:eu-repo/semantics/publishedVersio

Histological evaluation of the effect of low-level laser on distraction osteogenesis in rabbit mandibles

Objectives: This study evaluated the action of low level laser therapy (LLLT) on the percentage of newly formed bone in rabbit mandibles that underwent distraction osteogenesis (DO). Study design: Ten rabbits underwent bone lengthening according to the following protocol: Latency ? 3 days; Activation ? 7 days 0.7 mm/d; and Consolidation ? 10 days. The control group was composed of 4 rabbits. The experimental group, composed of 6 rabbits, received infrared GaAlAs LLLT (?=830 nm, P=40 mW) according to the following protocol: point dose of 10 J/cm2 applied directly on the bone site that underwent DO during bone consolidation at 48-hour intervals. Results: The percentage of newly formed bone was greater in the LLLT group (57.89%) than in the control group (46.75%) (p=0.006). Conclusion: The results suggest that LLLT had a positive effect on the percentage of newly formed bone. Betterquality bone sites may allow early removal of the osteogenic distractors, thus shortening total treatment time

UPLC-MS-QTOF analysis and antifungal activity of Cumaru (Amburana cearensis).

This study was aimed at investigating the phytochemical constituents, antifungal properties and antibiotic-modifying activity of the aqueous crude extract and fractions of Amburana cearensis seeds (CEFAC). The CEFAC were chemically characterized by LC–MS/MS–QTOF. In addition, the antifungal activity was assayed by the microdilution method against strains of Candida albicans. The phytochemical profile of CEFAC exhibited phenolic compounds, organic acids, and polyphenols. The results of the assessment of antifungal activity reveled an IC(50) ranging from 45.6 to 2048 µg/mL. Interestingly, when CEFAC was associated with Fluconazole, we evidenced a decreased IC(50) (1.81–11.9 µg/mL), suggesting a synergism with antibiotic. It was possible to identify in the crude extract and fractions several phenolic compounds, organic acids, and some polyphenols in positive ionization mode. These results suggest that CEFAC may present compounds with the ability to interact and act synergistically with antimicrobial drugs, highlighting its potential as an alternative source for the development of new antimicrobial agents

Análise do perfil de usuários atendidos em um centro de atenção psicossocial álcool e outras drogas/ Analysis of the profile of users assisted in a center for psychosocial care alcohol and other drugs

Objetivo: caracterizar o perfil sociodemográfico e clínico da clientela acompanhada em um Centro de Atenção Psicossocial álcool e outras drogas (CAPS ad). Metodologia: estudo documental realizado no período de março a junho de 2018 a partir dos prontuários de usuários admitidos em um CAPS ad em 2017 no município de Fortaleza, Ceará, Brasil. A amostra abrangeu 225 prontuários, os quais continham informações sobre os aspectos sociodemográficos e clínicos. Os dados foram analisados com associação entre variáveis e aplicação do teste Qui-quadrado de Pearson. Respeitaram-se os aspectos éticos. Resultados: o perfil predominante dos usuários é de homens, casados, com filhos, com baixo nível escolar e desempregados. As drogas mais consumidas foram o álcool e tabaco seguido da cocaína, havendo significância estatística (p= 0,000) quando relacionado à idade. Conclusão: o uso problemático de drogas foi associado especialmente às drogas lícitas e sua relação direta com o início precoce do uso de drogas psicoativas em geral. O padrão de uso majoritariamente diário distanciou os usuários do mercado de trabalho, da família e da rede social de apoio

Cirurgias potencialmente contaminadas: fatores de risco para infecção do sítio cirúgico: Potentially contaminated surgery: risk factors for infection at the surgical site

A Infecção Relacionada à Assistência à Saúde trata-se de um meio de estudo de grande preocupação dos serviços de saúde. Verifica-se que entre as topografias das IRAS, a Infecção de Sítio Cirúrgico está intimamente concernente aos procedimentos cirúrgicos, sendo, atualmente, uma das mais importantes entre as IRAS. A infeção relacionada à assistência à saúde é capaz de gerar graves consequências, abrangendo o aumento nos gastos devido ao seu tratamento e a um aumento do tempo de internação. O risco de morte dos pacientes com ISC vem se mostrando aumentado quando comparado aos que não desenvolveram a infecção. Diante da literatura encontrada contatou-se a existência de diferentes fatores de risco para ocorrência das infecções do sítio cirúrgico e dentre elas pode-se destacar o índice de massa corporal, tabagismo, hemotransfusão, doença crônica preexistente e também o potencial de contaminação da ferida operatória. Sabe-se que na literatura brasileira ainda existe uma exiguidade de estudo capazes de abordar procedimentos cirúrgicos o que, portanto, dificulta a utilização de estimativas de diferentes taxas de infecções do sítio cirúrgico e o consequente reconhecimento dos fatores de riscos associados. A maior parte dos ISC podem ser controladas, se obtiverem as intervenções adequadas, sendo estes integrantes críticos do programa para a segurança do paciente

Clinical and echocardiographic parameters associated with low chronotropic index in non-elderly patients

FUNDAMENTO: Apesar das inúmeras evidências de aumento da morbimortalidade, a incompetência cronotrópica (IC) ainda não é um diagnóstico rotineiro e bem definido nos protocolos de avaliação cardiológica e sua importância clínica ainda é subestimada. OBJETIVO: Avaliar os parâmetros clínicos e ecocardiográficos associados à IC em pacientes não idosos submetidos à ecocardiografia sob estresse físico (EEF). MÉTODOS: Foram avaliados 1.798 pacientes com idade média de 48,4 ± 7,5 anos submetidos à EEF entre Janeiro/2000 e Agosto/2009. Pacientes com índice cronotrópico menor que 0,8 foram considerados incompetentes cronotrópicos e comparados aos competentes quanto às características clínicas e ecocardiográficas. RESULTADOS: A duração do esforço físico foi em média de 9,3 ± 2,4 minutos. Duzentos e setenta (15%) pacientes eram incompetentes cronotrópicos. O índice cronotrópico de tal grupo foi de 0,7 ± 0,1 vs. 1,0 ± 0,1 para os competentes. A análise de regressão logística multivariada identificou os seguintes parâmetros como independentemente associados à IC: dispneia no exame [odds ratio (OR) = 4,27; p < 0,0001], dor torácica prévia na história clínica (OR = 1,51; p = 0,0111), maiores valores de índice de massa do ventrículo esquerdo nos incompetentes (IMVE) (OR = 1,16; p = 0,0001), equivalentes metabólicos (METs) (OR = 0,70; p = 0,0001), infradesnivelamento do segmento ST (OR = 0,58; p = 0,0003) e elevação da pressão arterial sistólica (ΔPAS) (OR = 0,87; p = 0,0011). Isquemia miocárdica não se associou à IC. CONCLUSÃO: A IC está associada a parâmetros funcionais, tais como: dispneia ao esforço, história de dor torácica e menores valores de METS. Está também associada ao parâmetro estrutural índice de massa do ventrículo esquerdo. Além disso, incompetência cronotrópica não parece aumentar a chance de isquemia miocárdica em pacientes não idosos. _________________________________________________________________________________________ ABSTRACT: BACKGROUND: Despite abundant evidence of increased morbidity and mortality, chronotropic incompetence (CI) is not a routine diagnosis well defined in protocols of cardiac evaluation and its clinical importance is still underestimated. OBJECTIVE: To evaluate the clinical and echocardiographic parameters associated with HF in non-elderly patients submitted to stress echocardiography (SE). METHODS: One thousand seven hundred ninety-eight patients with a mean age of 48.4 ± 7.5 years, who underwent SE between January/2000 and August/2009 were evaluated. Patients with chronotropic index smaller than 0.8 were considered chronotropic incompetent as compared to competent patients as to clinical and echocardiographic characteristics. RESULTS: The duration of the exercise was 9.3 ± 2.4 minutes on average. Two hundred and seventy (15%) patients were chronotropic incompetent. The chronotropic index of this group was 0.7 ± 0.1 vs. 1.0 ± 0.1 for competent patients. Multivariate logistic regression analysis identified the following parameters as independently associated with HF: dyspnea on examination [odds ratio (OR) = 4.27, p <0.0001], previous chest pain on medical history (OR = 1.51; p = 0.0111), higher left ventricular mass rate in incompetent patients (LVMI) (OR = 1.16, p = 0.0001), metabolic equivalents (METs) (OR = 0.70, p = 0 , 0001), ST segment depression (OR = 0.58, p = 0.0003) and high systolic blood pressure (ΔSBP) (OR = 0.87, p = 0.0011). Myocardial ischemia was not associated with HF. CONCLUSION: HF is associated with functional parameters, such as dyspnea on exertion, history of chest pain and lower METS. It is also associated with structural benchmark index of left ventricular mass. In addition, chronotropic incompetence does not appear to increase the chance of myocardial ischemia in non-elderly patients

Coleta de dados para pesquisa epidemiológica sobre a covid-19 na região Araguaia, Relato de experiência / Data collection for epidemiological research on covid-19 in the Araguaia region, Experience report

O Coronavírus é uma síndrome respiratória aguda grave (SARS-CoV-2) e sua transmissão se dá principalmente por meio do contato com fluidos advindos do sistema respiratório, além de contato com superfícies já contaminadas. Nesse sentido, foi elaborado o projeto de avaliação da epidemiologia da Covid-19 no Pará, com o objetivo de oferecer subsídios técnico-científicos para adoção de medidas eficazes e conforme as peculiaridades de cada região. Trata-se de um estudo descritivo, tipo relato de experiência, construído a partir da vivência dos acadêmicos de Enfermagem do 8° semestre da Universidade do Estado do Pará- Campus VII (UEPA) enquanto membros do grupo de pesquisa do “Estudo da proporção de casos de Covid-19 no Estado do Pará”. O presente relato de experiência visa descrever a perspectiva dos acadêmicos de enfermagem durante a coleta de dados da pesquisa epidemiológica, bem como, realizar uma descrição dos resultados levantados na referida pesquisa. O levantamento dos dados iniciou com a aplicação de questionário que permitiu identificar o perfil demográfico e socioeconômico da população. Em sequência, realizou-se a testagem IgG para a Covid-19, sendo o resultado disposto em uma ficha de notificação individual preenchida a cada dia de coleta, que continha identificação e dados clínicos referidos pelos participantes, sendo enviados à Secretaria de Saúde do Pará (SESPA). No presente relato destacam-se as experiências vivenciadas pelos autores nas cidades Conceição do Araguaia e Xinguara, pertencentes a região Araguaia, nesse sentido, participar das três etapas da pesquisa permitiu adquirir experiências, além do aperfeiçoamento dos saberes técnico-científicos frente à pandemia da Sars-CoV-2. Ressalta-se que o projeto nos preparou de maneira eficaz para a prática profissional durante os meses de pesquisa e esse conhecimento prevalecerá com os pesquisadores, inclusive no mercado de trabalho

Pharmacological treatment of hypertension guided by peripheral or central blood pressure: a comparison between the two strategies

BackgroundArterial hypertension treatment guided by central blood pressures (CPB) rather than peripheral blood pressures (PBP) measurement has the potential to show greater effectiveness in preventing or even regressing stiffness and target organ damage (TOD).ObjectiveThis study aimed to compare the parameters of CBP and PBP measurements, arterial stiffness, TOD and renal profile in patients with anti-hypertensive treatment guided by CBP or PBP targets.MethodsA randomized clinical trial was conducted in central group (CG) and peripheral group (PG). Patients were randomized, evaluated every 3 months for BP and antihypertensive adjustments during a one-year follow up. The procedures in V1 and V5: anthropometric assessment; CBP/PBP measurements, carotid ultrasound; echocardiography; laboratory tests. Paired and unpaired t-tests and the χ2 were used (significance level: 5%).ResultsThe study evaluated 59 participants (30CG/29PG). The augmentation index (AIx) was higher in the CG (27.3% vs. 20.3%, p = 0.041). Intergroup analysis has found central diastolic BP lower in the CG (78.9 vs. 84.3 mmHg, p = 0.024) and the Alx difference between groups ceased to exist after a one-year follow-up. Intragroup comparisons, after intervention, showed a lower frequency of changed PWV (p &lt; 0.001) and LVMI (p = 0.018) in the CG. The PG showed a higher frequency of changed PWV (p &lt; 0.001) and LVMI (p = 0.003).ConclusionThe intervention guided by central BP reduced the central diastolic BP and AIx compared to the PG. There was a reduction in the frequency of changed PWV and LVMI in the CG

Vigilância do câncer em Mato Grosso: aspectos metodológicos e operacionais de um projeto de extensão/pesquisa

Objective: To describe the methodological and operational aspects of the Cancer Surveillance Project and its associated factors: population-based and hospital-based registry (VIGICAN), in Mato Grosso (MT). Methods: VIGICAN was divided into two projects: an extension one, which updated the data from the Population-Based Cancer Registry (RCBP) of MT in the period 2008 to 2016; and one of research, which collected primary data, through individual interviews and analysis of medical records of people with a diagnosis of cancer, aged 18 years or over, treated at reference hospitals for oncology. To analyze the factors associated with cancer, the following variables were collected: socioeconomic and demographic, social support, status and health behavior, and environmental exposure. Results: In the períod from 2008 to 2016, approximately one hundred thousand cases of cancer (incident and prevalent) were reported in the RCBP Cuiabá and Interior. After validation procedures, fifty thousand incident cases were chosen. The survey interviewed 1,012 patients, 38.2% living in the municipalities of Cuiabá and Várzea Grande, 60.4% in the interior of the state and 1.4% in other states. Preliminary data revealed that the majority were female (55.0%) and younger than 60 years (54.3%). Among those interviewed, 7.2% reported smoking tobacco, 15.5% consumed alcoholic beverages (15.5%) and 32.7% lived close to crops. Conclusion: The development of these projects allowed the integration of education with health services and will enable the recognition of specificities and different exposure scenarios and factors associated with cancer in the Mato Grosso territory.Objetivo: Descrever os aspectos metodológicos e operacionais do Projeto Vigilância do Câncer e seus fatores associados: registro de base populacional e hospitalar (VIGICAN), em Mato Grosso (MT). Métodos: O VIGICAN se desdobrou em dois projetos: um de extensão, que atualizou os dados dos Registros de Câncer de Base Populacional (RCBP) de MT no período de 2008 a 2016; e um de pesquisa, que coletou dados primários, por meio de entrevistas individuais e análise de prontuários de pessoas com diagnóstico de câncer, com 18 anos ou mais, atendidas em hospitais de referência para oncologia. Para analisar os fatores associados ao câncer, foram coletadas as seguintes variáveis: socioeconômicas e demográficas, suporte social, situação e comportamentos de saúde e exposição ambiental. Resultados: No período de 2008 a 2016, foram notificados nos RCBP Cuiabá e Interior, aproximadamente, 100 mil casos de câncer (incidentes e prevalentes). Após procedimentos de validação, foram eleitos 50 mil casos incidentes. A pesquisa entrevistou 1.012 pacientes, sendo 38,2% residentes nos municípios de Cuiabá e Várzea Grande, 60,4% no interior do estado e 1,4% em outros estados. Os dados preliminares revelaram que a maioria era do sexo feminino (55,0%) e tinha menos de 60 anos (54,3%). Entre os entrevistados, 7,2% relataram fumar tabaco, 15,5% consumiam bebidas alcoólicas (15,5%) e 32,7% moravam próximos a lavouras. Conclusão: O desenvolvimento desses projetos permitiu a integração do ensino com os serviços de saúde e possibilitará o reconhecimento das especificidades e diferentes cenários de exposição e fatores associados ao câncer do território mato-grossense

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio