Dementia screening in Brazil: a systematic review of normative data for the mini-mental state examination

The Mini-Mental State Examination (MMSE) is the most widely used instrument for the screening of older adults with suspected cognitive impairment; the MMSE has been translated and validated in numerous languages and countries. The cultural and sociodemographic characteristics of the sample can influence performance on the test; therefore, applying the MMSE in different populations usually requires adjustments of those variables. From this perspective, the present study aims to review the normative data for the MMSE in the Brazilian older population, including those adaptations to the original test. Database searches were performed in Medline, Web of Knowledge, Scielo and Pepsic for articles assessing healthy elderly Brazilian samples using the MMSE. Heterogeneity across and within the studies was analyzed. Of a total of 1,085 retrieved articles, 14 were included. Significant differences across studies were identified for the characteristics of the samples, the presence of alterations to the MMSE subtests and the presentation of the results. The risk of biases was relevant for all the studies. Considering the large methodological heterogeneity among studies, the generalization of the available normative data for the MMSE may not be appropriate for the general elderly Brazilian population

Caracterização da microbiota associada a formigas capturadas em ambiente hospitalar

RESUMO: Inúmeros veículos de transmissão de microrganismos são conhecidos e tem seu papel na cadeia de infecção bem esclarecido dentro da comunidade científica, como os ratos, piolhos, pulgas e os mosquitos. Entretanto, formigas são vetores pouco considerados como fonte de infecção, mas possuem a mesma importância, principalmente quando se fala de infecção hospitalar. Diversos pesquisadores já demonstraram que esses artrópodes realizam simbiose com bactérias, sendo, portanto, vetores mecânicos destas. A partir disso, infecções nosocomiais se tornam possíveis em consequência do fato de as formigas circularem livremente pelas instalações hospitalares, entrando em contato com material infectado e logo depois com pacientes, medicamentos, aparelhos e utensílios, sala de Unidade de Terapia Intensiva (UTI), entre outros, disseminando os microrganismos patogênicos. O objetivo deste trabalho é analisar quais microrganismos potencialmente patogênicos são carreados nos corpos de formigas em dois hospitais da cidade de Anápolis – Goiás. O estudo será realizado a partir da captura das formigas em tubos de ensaio, após essa etapa será realizado o isolamento e identificação de bactérias no laboratório de microbiologia da UniEvangélica. As bactérias isoladas, então, serão submetidas ao teste de antibiograma por difusão em disco. Assim, pretende-se contribuir para o reconhecimento do mecanismo vetorial mediado por formigas em ambiente hospitalar e identificar a relação entre os microrganismos carreados e seu comportamento frente ao tratamento antibiótico padrão, além de fornecer respaldo científico para elaboração de novos procedimentos de segurança por controle de vetores em ambiente hospitalar. &nbsp

Caracterização da microbiota associada a formigas capturadas em ambiente hospitalar: revisão sistemática / Characterization of microbiota associated with ants captured in a hospital environment: systematic review

Inúmeros veículos de transmissão de microrganismos são conhecidos e tem seu papel na cadeia de infecção bem esclarecido dentro da comunidade científica, como os ratos, piolhos, pulgas e os mosquitos. Entretanto, formigas são vetores pouco considerados como fonte de infecção, mas possuem a mesma importância, principalmente no que se refere à infecção hospitalar. Diversos pesquisadores já demonstraram que esses artrópodes realizam simbiose com bactérias, sendo, portanto, vetores mecânicos destas. A partir disso, infecções nosocomiais se tornam possíveis em consequência do fato de as formigas circularem livremente pelas instalações hospitalares. O objetivo deste estudo foi descrever quais microrganismos potencialmente patogênicos são carreados nos corpos de formigas em hospitais. Foi feita uma pesquisa sistemática nas plataformas PubMed, Scientific Electronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) com os descritores (ants AND hospital) AND (bacteria) AND (infection) AND (insect vectors). Após a aplicação dos critérios pré-definidos de inclusão e exclusão, 16 referências foram selecionadas e exploradas nesse trabalho. Assim, pretende-se contribuir para o reconhecimento do mecanismo vetorial mediado por formigas em ambiente hospitalar e identificar a relação entre os microrganismos carreados, além de fornecer respaldo científico para elaboração de novos procedimentos de segurança por controle de vetores em ambiente hospitalar

Neuroplasticidade e estimulação do Nervo Vago: Revisão Integrativa dos avanços no tratamento da Epilepsia.

Introduction: Refractory epilepsy represents a challenge in neurology, affecting the quality of life of patients who do not respond to conventional pharmacological therapies. Vagus Nerve Stimulation (VNS) emerges as a promising approach. Methodology: This integrative review was based on 29 studies on VNS in the treatment of refractory epilepsy. The PICO strategy was used to construct the research question and articles were selected from databases such as MEDLINE/PubMed, Science Direct and LILACS. Results: VNS proved to be effective in reducing the frequency of epileptic seizures, with around 8% of patients achieving freedom from seizures. Side effects, such as headache and skin irritation, were mild and well tolerated. The therapy was especially beneficial for patients with specific epilepsy syndromes. However, the high cost of VNS can be a barrier for many patients. Conclusion: VNS is a safe and effective approach for the treatment of refractory epilepsy. Early intervention may be particularly beneficial, especially in pediatric patients. Future technological innovations could make ENV more accessible and effective.Introdução: A epilepsia refratária representa um desafio na neurologia, afetando a qualidade de vida dos pacientes que não respondem às terapias farmacológicas convencionais. A Estimulação do Nervo Vago (ENV) surge como uma abordagem promissora. Metodologia: Esta revisão integrativa foi baseada em 29 estudos sobre a ENV no tratamento da epilepsia refratária. Utilizou-se a estratégia PICO para a construção da pergunta de pesquisa e os artigos foram selecionados de bases de dados como MEDLINE/PubMed, Science Direct e LILACS. Resultados: A ENV mostrou-se eficaz na redução da frequência das crises epilépticas, com cerca de 8% dos pacientes alcançando liberdade de convulsões. Efeitos colaterais, como cefaleia e irritação da pele, foram leves e bem tolerados. A terapia foi especialmente benéfica para pacientes com síndromes epilépticas específicas. No entanto, o alto custo da ENV pode ser uma barreira para muitos pacientes. Conclusão: A ENV é uma abordagem segura e eficaz para o tratamento da epilepsia refratária. A intervenção precoce pode ser particularmente benéfica, especialmente em pacientes pediátricos. Futuras inovações tecnológicas podem tornar a ENV mais acessível e eficaz. &nbsp

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Brazilian recommendations of mechanical ventilation 2013. Part 2

O suporte ventilatório artificial invasivo e não invasivo ao paciente crítico tem evoluído e inúmeras evidências têm surgido, podendo ter impacto na melhora da sobrevida e da qualidade do atendimento oferecido nas unidades de terapia intensiva no Brasil. Isto posto, a Associação de Medicina Intensiva Brasileira (AMIB) e a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) - representadas pelo seus Comitê de Ventilação Mecânica e Comissão de Terapia Intensiva, respectivamente, decidiram revisar a literatura e preparar recomendações sobre ventilação mecânica objetivando oferecer aos associados um documento orientador das melhores práticas da ventilação mecânica na beira do leito, baseado nas evidencias existentes, sobre os 29 subtemas selecionados como mais relevantes no assunto. O projeto envolveu etapas visando distribuir os subtemas relevantes ao assunto entre experts indicados por ambas as sociedades que tivessem publicações recentes no assunto e/ou atividades relevantes em ensino e pesquisa no Brasil na área de ventilação mecânica. Esses profissionais, divididos por subtemas em duplas, responsabilizaram-se por fazer revisão extensa da literatura mundial sobre cada subtema. Reuniram-se todos no Forum de Ventilação Mecânica na sede da AMIB em São Paulo, em 03 e 04 de agosto de 2013 para finalização conjunta do texto de cada subtema e apresentação, apreciação, discussão e aprovação em plenária pelos 58 participantes, permitindo a elaboração de um documento final