O PAPEL DA ATIVIDADE FÍSICA NA PREVENÇÃO DA PROGRESSÃO DA DOENÇA DE ALZHEIMER: UMA REVISÃO BIBLIOGRÁFICA

Introduction: Alzheimer's disease (AD) is a common form of dementia and represents a growing public health challenge due to the aging of the population. Physical activity has been studied as a potential intervention in the prevention and treatment of AD. Objective: This literature review seeks to demonstrate the role of physical activity in preventing the progression of AD. Methods: This literature review was conducted through a systematic search of scientific literature published in the last 20 years, covering the period from 2004 to 2024, using specific inclusion and exclusion criteria, and electronic databases: PubMed, Web of Science, Scopus and Google Scholar. Results and Discussion: Consistent evidence has shown an inverse association between physical activity and the risk of developing AD, with additional benefits in cognitive function in patients diagnosed with the disease. Neurobiological mechanisms, such as reducing inflammation and promoting neuroplasticity, may contribute to these beneficial effects. However, adherence to exercise programs remains a challenge, especially in vulnerable populations. Conclusion: Physical activity is emerging as a promising intervention in the prevention and treatment of AD, with the potential to improve brain health and quality of life. Integrated and personalized strategies are needed to maximize the benefits of physical activity in vulnerable populations, highlighting the importance of physical activity in the treatment of AD.Introducción: La enfermedad de Alzheimer (EA) es una forma común de demencia y representa un reto creciente para la salud pública debido al envejecimiento de la población. La actividad física se ha estudiado como posible intervención en la prevención y el tratamiento de la EA. Objetivo: Esta revisión bibliográfica pretende demostrar el papel de la actividad física en la prevención de la progresión de la EA. Métodos: Esta revisión bibliográfica se realizó mediante una búsqueda sistemática de la literatura científica publicada en los últimos 20 años, abarcando el período comprendido entre 2004 y 2024, utilizando criterios específicos de inclusión y exclusión, y bases de datos electrónicas: PubMed, Web of Science, Scopus y Google Scholar. Resultados y Discusión: Evidencias consistentes han demostrado una asociación inversa entre la actividad física y el riesgo de desarrollar EA, con beneficios adicionales en la función cognitiva en pacientes diagnosticados con la enfermedad. Los mecanismos neurobiológicos, como la reducción de la inflamación y la promoción de la neuroplasticidad, pueden contribuir a estos efectos beneficiosos. Sin embargo, la adherencia a los programas de ejercicio sigue siendo un reto, especialmente en poblaciones vulnerables. Conclusión: La actividad física se perfila como una intervención prometedora en la prevención y el tratamiento de la EA, con el potencial de mejorar la salud cerebral y la calidad de vida. Se necesitan estrategias integradas y personalizadas para maximizar los beneficios de la actividad física en poblaciones vulnerables, destacando la importancia de la actividad física en el tratamiento de la EA.Introdução: A doença de Alzheimer (DA) é uma forma comum de demência, representando um desafio crescente para a saúde pública devido ao envelhecimento da população. A atividade física tem sido estudada como uma intervenção potencial na prevenção e tratamento da DA. Objetivo: Esta revisão de literatura busca demonstrar o papel da atividade física na prevenção da progressão da DA. Métodos: Esta revisão bibliográfica foi conduzida por meio de uma busca sistemática na literatura científica publicada nos últimos 20 anos, abrangendo o período de 2004 a 2024, utilizando critérios de inclusão e exclusão específicos, e as bases de dados eletrônicas: PubMed, Web of Science, Scopus e Google Scholar. Resultados e Discussão: Evidências consistentes demonstraram uma associação inversa entre atividade física e risco de desenvolvimento de DA, com benefícios adicionais na função cognitiva em pacientes diagnosticados com a doença. Mecanismos neurobiológicos, como a redução da inflamação e a promoção da neuroplasticidade, podem contribuir para esses efeitos benéficos. No entanto, a adesão a programas de exercícios permanece um desafio, especialmente em populações vulneráveis. Conclusão: A atividade física emerge como uma intervenção promissora na prevenção e tratamento da DA, com potencial para melhorar a saúde cerebral e a qualidade de vida. Estratégias integradas e personalizadas são necessárias para maximizar os benefícios da atividade física em populações vulneráveis, destacando a importância de abordagens colaborativas entre profissionais de saúde.Introdução: A doença de Alzheimer (DA) é uma forma comum de demência, representando um desafio crescente para a saúde pública devido ao envelhecimento da população. A atividade física tem sido estudada como uma intervenção potencial na prevenção e tratamento da DA. Objetivo: Esta revisão de literatura busca demonstrar o papel da atividade física na prevenção da progressão da DA. Métodos: Esta revisão bibliográfica foi conduzida por meio de uma busca sistemática na literatura científica publicada nos últimos 20 anos, abrangendo o período de 2004 a 2024, utilizando critérios de inclusão e exclusão específicos, e as bases de dados eletrônicas: PubMed, Web of Science, Scopus e Google Scholar. Resultados e Discussão: Evidências consistentes demonstraram uma associação inversa entre atividade física e risco de desenvolvimento de DA, com benefícios adicionais na função cognitiva em pacientes diagnosticados com a doença. Mecanismos neurobiológicos, como a redução da inflamação e a promoção da neuroplasticidade, podem contribuir para esses efeitos benéficos. No entanto, a adesão a programas de exercícios permanece um desafio, especialmente em populações vulneráveis. Conclusão: A atividade física emerge como uma intervenção promissora na prevenção e tratamento da DA, com potencial para melhorar a saúde cerebral e a qualidade de vida. Estratégias integradas e personalizadas são necessárias para maximizar os benefícios da atividade física em populações vulneráveis, destacando a importância de abordagens colaborativas entre profissionais de saúde

AVALIAÇÃO DA EFICÁCIA DAS NOVAS TERAPIAS ANTICOAGULANTES ORAIS NA PREVENÇÃO DE EVENTOS RELACIONADOS À FIBRILAÇÃO ATRIAL: UMA REVISÃO BIBLIOGRÁFICA

Introduction: Atrial fibrillation is a common clinical condition associated with a significant increase in the risk of cardiovascular events, such as stroke. The advent of new oral anticoagulant therapies, such as direct inhibitors of factor Xa and thrombin, has brought new perspectives for the treatment and prevention of these events. Objective: This literature review aims to evaluate the efficacy of new oral anticoagulant therapies in the prevention of cardiovascular events related to atrial fibrillation. Methods: This literature review was conducted through a systematic search of the scientific literature published in the last 15 years, covering the period from 2009 to 2024, using the PubMed, Web of Science, Scopus, and Google Scholar databases. Original studies and reviews investigating the characteristics of new oral anticoagulant therapies and their efficacy in preventing cardiovascular events in patients with atrial fibrillation were included. Results and Discussion: The reviewed studies highlighted the efficacy of new oral anticoagulant therapies in reducing the risk of cardiovascular events, such as stroke, compared to warfarin. In addition, these drugs have shown a favorable safety profile, with a lower incidence of intracranial bleeding. Adherence and compliance with treatment were also highlighted as advantages of the new therapies, contributing to a better quality of life for patients. Conclusion: The review highlighted the importance of new oral anticoagulant therapies in clinical practice, providing a comprehensive and up-to-date analysis of their efficacy, safety, and economic impact.Introducción: La fibrilación auricular es una condición clínica frecuente asociada a un aumento significativo del riesgo de eventos cardiovasculares, como el ictus. El advenimiento de nuevas terapias anticoagulantes orales, como los inhibidores directos del factor Xa y la trombina, ha traído nuevas perspectivas para el tratamiento y la prevención de estos eventos. Objetivo: Esta revisión bibliográfica tiene como objetivo evaluar la eficacia de las nuevas terapias anticoagulantes orales en la prevención de eventos cardiovasculares relacionados con la fibrilación auricular. Métodos: Esta revisión bibliográfica se realizó a través de una búsqueda sistemática de la literatura científica publicada en los últimos 15 años, abarcando el período de 2009 a 2024, utilizando las bases de datos PubMed, Web of Science, Scopus y Google Scholar. Se incluyeron estudios originales y revisiones que investigaran las características de las nuevas terapias anticoagulantes orales y su eficacia en la prevención de eventos cardiovasculares en pacientes con fibrilación auricular. Resultados y discusión: Los estudios revisados destacaron la eficacia de las nuevas terapias anticoagulantes orales en la reducción del riesgo de eventos cardiovasculares, como el accidente cerebrovascular, en comparación con la warfarina. Además, estos fármacos han mostrado un perfil de seguridad favorable, con una menor incidencia de hemorragia intracraneal. También se destacaron la adherencia y el cumplimiento del tratamiento como ventajas de las nuevas terapias, contribuyendo a una mejor calidad de vida de los pacientes. A fibrilação atrial é uma condição clínica comum associada a um aumento significativo no risco de eventos cardiovasculares, como o acidente vascular cerebral (AVC). O advento das novas terapias anticoagulantes orais, como os inibidores diretos do fator Xa e da trombina, trouxe novas perspectivas para o tratamento e prevenção desses eventos. Objetivo: Esta revisão bibliográfica tem como objetivo avaliar a eficácia das novas terapias anticoagulantes orais na prevenção de eventos cardiovasculares relacionados à fibrilação atrial. Métodos: Esta revisão bibliográfica foi conduzida por meio de uma busca sistemática na literatura científica publicada nos últimos 15 anos, abrangendo o período de 2009 a 2024, utilizando as bases de dados PubMed, Web of Science, Scopus e Google Scholar. Foram incluídos estudos originais e revisões que investigaram as características das novas terapias anticoagulantes orais e sua eficácia na prevenção de eventos cardiovasculares em pacientes com fibrilação atrial. Resultados e Discussão: Os estudos revisados destacaram a eficácia das novas terapias anticoagulantes orais na redução do risco de eventos cardiovasculares, como o AVC, em comparação com a varfarina. Além disso, esses medicamentos mostraram um perfil de segurança favorável, com menor incidência de sangramento intracraniano. A adesão e conformidade ao tratamento também foram ressaltadas como vantagens das novas terapias, contribuindo para uma melhor qualidade de vida dos pacientes. Conclusão: A revisão evidenciou a importância das novas terapias anticoagulantes orais na prática clínica, fornecendo uma análise abrangente e atualizada sobre sua eficácia, segurança e impacto econômico.Introdução: A fibrilação atrial é uma condição clínica comum associada a um aumento significativo no risco de eventos cardiovasculares, como o acidente vascular cerebral (AVC). O advento das novas terapias anticoagulantes orais, como os inibidores diretos do fator Xa e da trombina, trouxe novas perspectivas para o tratamento e prevenção desses eventos. Objetivo: Esta revisão bibliográfica tem como objetivo avaliar a eficácia das novas terapias anticoagulantes orais na prevenção de eventos cardiovasculares relacionados à fibrilação atrial. Métodos: Esta revisão bibliográfica foi conduzida por meio de uma busca sistemática na literatura científica publicada nos últimos 15 anos, abrangendo o período de 2009 a 2024, utilizando as bases de dados PubMed, Web of Science, Scopus e Google Scholar. Foram incluídos estudos originais e revisões que investigaram as características das novas terapias anticoagulantes orais e sua eficácia na prevenção de eventos cardiovasculares em pacientes com fibrilação atrial. Resultados e Discussão: Os estudos revisados destacaram a eficácia das novas terapias anticoagulantes orais na redução do risco de eventos cardiovasculares, como o AVC, em comparação com a varfarina. Além disso, esses medicamentos mostraram um perfil de segurança favorável, com menor incidência de sangramento intracraniano. A adesão e conformidade ao tratamento também foram ressaltadas como vantagens das novas terapias, contribuindo para uma melhor qualidade de vida dos pacientes. Conclusão: A revisão evidenciou a importância das novas terapias anticoagulantes orais na prática clínica, fornecendo uma análise abrangente e atualizada sobre sua eficácia, segurança e impacto econômico

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

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 understanding 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,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 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 underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities 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 organism 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 neglected 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 lost

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 understanding 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,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 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 underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities 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 organism 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 neglected 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 lost

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries