Conocimiento, confianza y experiencia clínica de los fisioterapeutas y el equipo multiprofesional sobre la rehabilitación pulmonar

The knowledge deficit of health professionals has beena barrier to expanding and implementing pulmonary rehabilitation(PR) services, despite its reported benefits for individuals withchronic respiratory disease (CRD). This survey is part of a largerproject to implement PR in the Brazilian public health system,by assessing the preparedness of health care professionals from twoBrazilian cities to perform it. A self-administered questionnaire wasused to assess the knowledge (19 questions), training (7 questions),confidence (10 questions), and clinical experience (8 questions)of physical therapists (PT) and the multiprofessional team (MT)before a PR workshop. In total, 44 PT and 231 MT answered thequestionnaire. The mean total knowledge score was 10±3 for PTand 6±3 for MT. Few physical therapist reported having “a lot” ofexperience (25%) and confidence (22.7%) to perform PR, as well assufficient training to conduct the six-minute walk test (27.3%).Evenfewer MT reported having “a lot” of experience (10%) and sufficienttraining (4.8%) to perform PR, as well as to plan the educationalprogram for patients (10%) and the confidence to refer patients toPR (6.5%). This is the first study to evaluate the preparedness ofprofessionals from the Brazilian public health network to providePR. Notably, both PT and MT have low preparation to perform PRin the studied cities, reinforcing the need for continuing education.O déficit de conhecimento dos profissionaisde saúde tem sido uma barreira para a expansão eimplementação dos serviços de reabilitação pulmonar(RP), apesar dos seus benefícios comprovados paraindivíduos com doença respiratória crônica (DRC).Objetivo: avaliar o preparo dos profissionais de saúde dedois municípios brasileiros para fornecer a RP no sistemapúblico de saúde. Esse estudo, do tipo survey, foi parte deum projeto maior para implementação da RP no sistemapúblico de saúde brasileiro. Foi utilizado um questionárioautoaplicável para avaliar o conhecimento (19 questões),o treinamento (7 questões), a confiança (10 questões) e aexperiência clínica (8 questões) dos fisioterapeutas (FT)e da equipe multiprofissional (EM), aplicado antes de umworkshop sobre RP. No total, 44 FT e 231 EM responderamo questionário. A pontuação média de conhecimentofoi de 10±3 para FT e 6±3 para EM. Poucos FT referiamter “muita” experiência (25%) e confiança (22,7%) pararealizar RP, bem como treinamento suficiente pararealizar o teste de caminhada de seis minutos (27,3%).Ainda menos profissionais da EM relataram ter “muita”experiência (10%) e treinamento suficiente (4,8%)para realizar RP, assim como para planejar o programaeducacional dos pacientes (10%) e ter confiança paraencaminhar pacientes para a RP (6,5%). Este é o primeiroestudo a avaliar o preparo dos profissionais da redepública de saúde no Brasil para fornecer RP. Notavelmente,tanto FT quanto EM têm baixo preparo para realizar RPnos municípios estudados, reforçando a necessidade derealização de educação continuadaEl déficit de conocimientos entre los profesionales dela salud ha sido una barrera para la expansión e implementaciónde los servicios de rehabilitación pulmonar (RP) a pesar de susbeneficios comprobados para las personas con enfermedadrespiratoria crónica (ERC). Este estudio de encuesta forma partede un proyecto más amplio para implantar la RP en el sistemapúblico sanitario brasileño mediante la evaluación de la preparaciónde los profesionales sanitarios de dos municipios brasileños paraproporcionarla. Se utilizó un cuestionario autoadministrado paraevaluar los conocimientos (19 preguntas), la formación (7 preguntas),la confianza (10 preguntas) y la experiencia clínica (8 preguntas) delos fisioterapeutas (FT) y del equipo multiprofesional (EM), aplicadopreviamente en un taller sobre RP. La puntuación media de losconocimientos fue de 10±3 para FT y de 6±3 para EM. Menos de untercio de los FT afirmaron que tenían “mucha” experiencia (25%) yconfianza (22,7%) para realizar la RP, así como formación suficientepara realizar la prueba de la marcha de seis minutos (27,3%). Pocosprofesionales del EM declararon que tenían “mucha” experiencia(10%) y formación suficiente (4,8%) para realizar la RP, así comopara planificar el programa educativo (10%) y tenían confianza paraderivar a pacientes para la RP (6,5%). Este es el primer estudioque evalúa la preparación de los profesionales de la red públicade salud en Brasil para proporcionar la RP, y se observa que, en losmunicipios donde se realizó, tanto los FT como el EM están pocopreparados para llevarla a cabo, lo que refuerza la necesidad deuna formación continuada

Equação de predição para o miniexame do estado mental: influência da educação, idade e sexo

O mini-exame do estado mental (MEEM) é um teste de rastreio mundialmente utilizado para identificar alterações no âmbito da cognição. Estudos têm demonstrado a influência da educação, idade e gênero na pontuação do MEEM. No entanto, no Brasil, os estudos consideram apenas um fator para a pontuação no teste. O objetivo do estudo foi estabelecer uma equação preditiva para o MEEM. Um estudo transversal exploratório foi desenvolvido e examinadores treinados avaliaram participantes da comunidade. Os voluntários foram avaliados pelo MEEM e pela Escala de Depressão Geriátrica (EDG). A pontuação do MEEM foi a variável dependente. A idade, nível educacional, gênero e pontuação na EDG foram as variáveis independentes. A análise de regressão multivariada foi utilizada para determinar o modelo de melhor valor preditivo para os escores do MEEM. Foram avaliados 250 indivíduos entre 20 e 99 anos, sem comprometimento cognitivo. O nível educacional, a idade e o sexo explicaram 38% da variância total da pontuação do MEEM (p<0,0001) e resultaram na equação: MEEM=23,350+0,265(anos de escolaridade)-0,042(idade)+1,323(gênero), em que mulher=1 e homem=2. A pontuação do MEEM pode ser melhor explicada e predita quando o nível educacional, idade e gênero são considerados. Os resultados contribuem para o conhecimento sobre as variáveis que influenciam o escore do MEEM, bem como fornece uma maneira de considerá-las na pontuação do teste, proporcionando uma melhor triagem desses pacientes.El mini-examen del estado mental (MEEM) es una prueba de rastreo mundialmente utilizada para identificar alteraciones en el ámbito de la cognición. Los estudios han demostrado la influencia de la educación, la edad y el sexo en la puntuación del MEEM. Sin embargo, en Brasil, los estudios consideran sólo un factor para la puntuación en la prueba. El objetivo del estudio fue establecer una ecuación predictiva para el MEEM. Un estudio transversal exploratorio fue desarrollado y examinadores entrenados evaluaron a participantes de la comunidad. Los participantes fueron evaluados por el MEEM y la Escala de Depresión Geriátrica (EDG). La puntuación del MEEM fue la variable dependiente. La edad, nivel educativo, sexo y puntuación en la EDG fueron las variables independientes. El análisis de regresión multivariada fue utilizado para determinar el modelo de mejor valor predictivo para los escores del MEEM. Se evaluaron 250 individuos entre 20 y 99 años, sin comprometimiento cognitivo. El nivel educativo, la edad y el sexo explicaron el 38% de la varianza total de la puntuación del MEEM (p <0,0001) y resultaron en la ecuación: MEEM=23,350+0,265(años de escolaridad)-0,042 (edad)+1,323 (sexo), en que mujer = 1 y hombre = 2. La puntuación del MEEM puede ser mejor explicada y predecible cuando se considera el nivel educativo, la edad y el sexo. Los resultados contribuyen para el conocimiento sobre las variables que influencian el score del MEEM, así como proporciona una manera de considerar las variables en la puntuación de la prueba, proporcionando una mejor forma de triar a estos pacientes.The mini-mental state examination (MMSE) is a screening test used worldwide for identifying changes in the scope of cognition. Studies have shown the influence of education, age and sex in the MMSE score. However, in Brazil, the studies consider only one factor to score it. The aim of this study was to establish a prediction equation for the MMSE. An exploratory cross-sectional study was developed and trained researchers examined participants at the community. The volunteers were evaluated by the MMSE and also by the Geriatric Depression Scale (GDS). The MMSE score was the dependent variable. Age, educational level, sex, and GDS score were the independent variables. Multivariate regression analysis was used to determine the model of best prediction value for MMSE scores. A total of 250 participants aged 20-99 years, without cognitive impairment, were assessed. The educational level, age, and sex explained 38% of the total variance of the MMSE score (p<0.0001) and resulted in the following equation: MMSE=23.350+0.265(years of schooling)- 0.042(age)+1.323(sex), in which female=1 and male=2. The MMSE scores can be better explained and predicted when educational level, age, and sex are considered. These results enhance the knowledge regarding the variables that influence the MMSE score, as well as provide a way to consider all of them in the test score, providing a better screening of these patients

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

Knowledge, confidence, and clinical experience of physiotherapists and multiprofessional team on pulmonary rehabilitation

ABSTRACT The knowledge deficit of health professionals has been a barrier to expanding and implementing of pulmonary rehabilitation (PR) services, despite the reported benefits of PR for individuals with Chronic Respiratory Disease (CRD). This study aims to assess the preparedness of health care professionals from two Brazilian cities to perform PR in the public health system. This is survey is part of a larger project to implement PR in the Brazilian public health system. A self-administered questionnaire was used to assess the knowledge (19 questions), training (7 questions), confidence (10 questions), and clinical experience (8 questions) of physical therapists (PT) and the multiprofessional team (MT) before a PR workshop. In total, 44 PT and 231 MT answered the questionnaire. The mean total knowledge score was 10±3 for PT and 6±3 for MT. Few physical therapist reported having “a lot” of experience (25%) and confidence (22.7%) to perform PR, as well as sufficient training to conduct the six-minute walk test (27.3%).Even fewer MT reported having “a lot” of experience (10%) and sufficient training (4.8%) to perform PR, as well as to plan the educational program for patients (10%) and the confidence to refer patients to PR (6.5%). This is the first study to evaluate the preparedness of professionals from the Brazilian public health network to provide PR. Notably, both PT and MT have low preparation to perform PR in the studied cities, reinforcing the need for continuing education

Comparison of three protocols for measuring the maximal respiratory pressures

Introduction: To avoid the selection of submaximal efforts during the assessment of maximal inspiratory and expiratory pressures (MIP and MEP), some reproducibility criteria have been suggested. Criteria that stand out are those proposed by the American Thoracic Society (ATS) and European Respiratory Society (ERS) and by the Brazilian Thoracic Association (BTA). However, no studies were found that compared these criteria or assessed the combination of both protocols. Objectives: To assess the pressure valuesselected and the number of maneuvers required to achieve maximum performance using the reproducibility criteria proposed by the ATS/ERS, the BTA and the present study. Materials and method: 113 healthy subjects (43.04 ± 16.94 years) from both genders were assessed according to the criteria proposed by the ATS/ERS, BTA and the present study. Descriptive statistics were used for analysis, followed by ANOVA for repeated measures and post hoc LSD or by Friedman test and post hoc Wilcoxon, accordingto the data distribution. Results: The criterion proposed by the present study resulted in a significantlyhigher number of maneuvers (MIP and MEP median and 25%-75% interquartile range: 5[5-6], 4[3-5] and 3[3-4] for the present study criterion, BTA and ATS/ERS, respectively; p elt; 0.01) and higher pressure values (MIP mean and 95% confidence interval: 103[91.43-103.72], 100[97.19-108.83] and 97.6[94.06-105.95]; MEP: median and 25%-75% interquartile range: 124.2[101.4-165.9], 123.3[95.4-153.8] and 118.4[95.5-152.7]; p elt; 0.05). Conclusion: The proposed criterion resulted in the selection of pressure values closer to the individuals maximal capacity. This new criterion should be considered in future studies concerning MIP and MEP measurements

Comparison of three protocols for measuring the maximal respiratory pressures

Introduction To avoid the selection of submaximal efforts during the assessment of maximal inspiratory and expiratory pressures (MIP and MEP), some reproducibility criteria have been suggested. Criteria that stand out are those proposed by the American Thoracic Society (ATS) and European Respiratory Society (ERS) and by the Brazilian Thoracic Association (BTA). However, no studies were found that compared these criteria or assessed the combination of both protocols. Objectives To assess the pressure values selected and the number of maneuvers required to achieve maximum performance using the reproducibility criteria proposed by the ATS/ERS, the BTA and the present study. Materials and method 113 healthy subjects (43.04 ± 16.94 years) from both genders were assessed according to the criteria proposed by the ATS/ERS, BTA and the present study. Descriptive statistics were used for analysis, followed by ANOVA for repeated measures and post hoc LSD or by Friedman test and post hoc Wilcoxon, according to the data distribution. Results The criterion proposed by the present study resulted in a significantly higher number of maneuvers (MIP and MEP – median and 25%-75% interquartile range: 5[5-6], 4[3-5] and 3[3-4] for the present study criterion, BTA and ATS/ERS, respectively; p < 0.01) and higher pressure values (MIP – mean and 95% confidence interval: 103[91.43-103.72], 100[97.19-108.83] and 97.6[94.06-105.95]; MEP: median and 25%-75% interquartile range: 124.2[101.4-165.9], 123.3[95.4-153.8] and 118.4[95.5-152.7]; p < 0.05). Conclusion The proposed criterion resulted in the selection of pressure values closer to the individual’s maximal capacity. This new criterion should be considered in future studies concerning MIP and MEP measurements

Recovery of Brucella in raw milk minas artisanal cheese approved for consumption by official inspection agency in Brazil: assessment of prevalence and risk factors through One Health integrated approaches

SEG 06.11.01.012.00.00/Brazilian Agricultural Research Corporation / CVZ-APQ-02746-14/FAPEMIGEmbrapa Dairy Cattle. Juiz de Fora, MG, Brazil.Minas Gerais Agriculture and Livestock Institute. Belo Horizonte, MG, Brazil.Minas Gerais Agriculture and Livestock Institute. Belo Horizonte, MG, Brazil.Embrapa Dairy Cattle. Juiz de Fora, MG, Brazil.Minas Gerais Agriculture and Livestock Institute. Belo Horizonte, MG, Brazil.Embrapa Dairy Cattle. Juiz de Fora, MG, Brazil.Embrapa Dairy Cattle. Juiz de Fora, MG, Brazil.Brazilian Ministry of Agriculture. Livestock and Food Supply. Pedro Leopoldo, MG, Brazil.Brazilian Ministry of Agriculture. Livestock and Food Supply. Pedro Leopoldo, MG, Brazil.Brazilian Ministry of Agriculture. Livestock and Food Supply. Pedro Leopoldo, MG, Brazil.Brazilian Ministry of Agriculture. Livestock and Food Supply. Pedro Leopoldo, MG, Brazil.Embrapa Beef Cattle. Campo Grande, MS, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Geoprocessamento. Ananindeua, PA, Brasil.Marinha do Brasil. Rio de Janeiro, RJ, Brazil.University of Washington. School of Medicine. Seattle, WA, US.Brazilian Ministry of Agriculture. Livestock and Food Supply. Pedro Leopoldo, MG, Brazil.Background: Minas artisanal cheese (MAC) from the Serro region is a Brazilian intangible cultural heritage. Produced from raw milk, it may carry zoonotic pathogens such as Brucella. This study included a randomized survey for the prevalence of Brucella-positive MAC and its associated factors. Methods: MAC samples (n=55), each one from a different rural family-based cheese-processing agroindustry, were analysed for Brucella by direct polymerase chain reaction (PCR) species-specific DNA detection and cultivation-based approaches. Results: Among 55 MACs that were analysed, we found 17 Brucella DNA-positive samples (30.9% [95% confidence interval {CI} 18.7 to 43.1]) by PCR and, for the first time, from one MAC (1.8% [95% CI 0.5 to 9.7]), viable Brucella abortus was recovered by cultivation. Higher values for two variables, the number of lactating cows per herd (p=0.043) and daily milk production per herd (p=0.043), were each associated with Brucella-positive MAC, which concentrated in three high-risk and one low-risk spatial clusters. Conclusions: MAC may be a source of Brucella for humans, since the positive samples were from batches that were sold by cheesemakers. This should be of concern and encourage cooperation between the health and agriculture sectors in order to mitigate this public health risk through One Health integrated approaches