PROGRAMAS DE ATIVIDADE FÍSICA PARA PRÉ-DIABÉTICOS E SAÚDE PÚBLICA: REVISÃO SISTEMÁTICA UTILIZANDO O MODELO RE-AIM

Aim: This study aimed to analyze articles on physical activity programs for people with prediabetes, investigating the use of these programs as a public health strategy. Method: A systematic review of the evaluation was conducted based on the RE-AIM model's checklist, including articles in English, Portuguese and Spanish published between January 2007 and December 2017. Results: Seventy-six articles were examined. Information related to internal validation (target population, sample size, inclusion criteria, mediators, time and duration of the program) was observed, as well as information related to external validation (general program cost, treatment intensity, data imputation, adaptations, individual assessment during the permanency period). Conclusion: It is concluded that there is a lack of information about the programs in the articles, which makes their implementation/dissemination difficult or unfeasible as a public policy aimed at health.Objetivo: O objetivo do estudo foi analisar artigos sobre programas de atividade física para pessoas com pré-diabetes visando investigar a adoção desses programas como estratégia de saúde pública. Método: Realizou-se uma revisão sistemática a partir da avaliação por meio do check-list do modelo RE-AIM, sendo incluído artigos em inglês, português e espanhol publicados entre janeiro de 2007 a dezembro de 2017. Resultados: Setenta e seis artigos foram analisados. Observou-se informações relacionadas a validade interna (população-alvo, tamanho da amostra, critério de inclusão, mediadores, tempo e duração de programa) e as informações relacionadas a validade externa (custo geral do programa, intensão de tratamento, imputação dos dados, adaptações, avaliação individual durante o período de manutenção). Conclusão: Conclui-se que há ausência de informações, que dificultam ou inviabilizam sua implementação/disseminação enquanto política pública voltada para a saúde

Programas de exercício físico para pessoas pré-hipertensas: revisão com base no modelo RE-AIM

Há evidências em estudos com alto controle de variáveis e grupos homogêneos (validade interna) de que o exercício físico reduz os índices pressóricos em pessoas com pré-hipertensão (PH). Entretanto, não se sabe ao certo se esses estudos apresentam informações suficientes para que tais exercícios sejam aplicados na prática clínica, no dia-a-dia (validade externa). Objetivo: O objetivo foi avaliar se os artigos científicos sobre programas de exercício físico para pessoas com pré-hipertensão da principal base de dados biomédica apresentam informações suficientes sobre a sua validade interna e externa. Métodos: Foi realizada uma revisão sistemática no PubMed entre 2007 a 2017, de artigos publicados inglês, espanhol ou português. Para seleção dos artigos, dois pareceristas (e um terceiro em caso de discordância) avaliaram o título, o resumo e o texto completo. Após esta etapa, foi realizada a avaliação da validade interna e externa utilizando o check-list do modelo de avaliação RE-AIM. Resultados: Foram encontrados 11.693 artigos para leitura dos títulos. Destes, 7 foram selecionados para leitura dos resumos, 5 artigos para leitura na íntegra, finalizando o processo com 3 artigos selecionados para a análise pelo modelo RE-AIM. Dos artigos selecionados, observou-se que os artigos atenderam apenas 33,33% dos itens das dimensões Alcance (público alvo e participante da pesquisa) e Implementação. No check-list da dimensão Efetividade/Eficácia (resultados) apenas 12,5% foram atendidos. As dimensões Adoção (organização e equipe alvo e participante) e Manutenção não foram contempladas. Conclusão: os artigos apresentam poucas informações a respeito da validade externa, dificultando assim a possibilidade de disseminação desses protocolos de exercício físico para outras realidades

Evidence for Host Epigenetic Signatures Arising From Arbovirus Infections: A Systematic Review

Background: Arbovirus infections have steadily become a major pandemic threat. This study aimed at investigating the existence of host epigenetic markers arising from the principal arboviruses infections impacting on human health. We set to systematically review all published evidence describing any epigenetic modifications associated with infections from arboviruses, including, but not limited to, microRNAs, DNA methylation, and histone modifications.Methods: A comprehensive search was conducted using the electronic databases PubMed, Science Direct and Cochrane Library from inception to January 4th, 2018. We included reports describing original in vivo or in vitro studies investigating epigenetic changes related to arbovirus infections in either clinical subjects or human cell lines. Studies investigating epigenetic modifications related to the virus or the arthropod vector were excluded. A narrative synthesis of the findings was conducted, contextualizing comparative evidence from in vitro and in vivo studies.Results: A total of 853 unique references were identified and screened by two independent researchers. Thirty-two studies met the inclusion criteria and were reviewed. The evidence was centered mainly on microRNA and DNA methylation signatures implicated with secondary Dengue fever. Evidence for recent epidemic threats, such as the infections by Zika or Chikungunya viruses is still scant.Conclusions: Major epigenetic alterations found on arboviruses infections were miR-146, miR-30e and the Dicer complex. However, existing studies frequently tested distinct hypotheses resulting in a heterogeneity of methodological approaches. Whilst epigenetic signatures associated with arbovirus infections have been reported, existing studies have largely focused on a small number of diseases, particularly dengue. Validation of epigenetic signatures have an untapped potential, but concerted investigations are certainly required to deliver robust candidates of clinical utility for diagnosis, staging and prognosis of specific arboviral diseases

Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial

OBJECTIVE: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage

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

Biblioteca como espaço de inclusão de pessoas com deficiência no mercado de trabalho: estudo de caso da contratação da APAE-DF pela Biblioteca do Ministério da Justiça

O presente trabalho é um relato de experiência sobre a inclusão de alunos da APAE-DF – Associação de Paes e Amigos dos Excepcionais do Distrito Federal para desenvolverem trabalho remunerado na Biblioteca do Ministério da Justiça e Segurança Pública. Entende-se que é função da biblioteca atuar na construção de uma sociedade plural, a qual contribua para o desenvolvimento de uma mentalidade coletiva em prol da mitigação das diferenças. Por mais que as políticas de inclusão das pessoas com necessidades especiais físicas e mentais tenham avançado no país, a inclusão destas no mercado de trabalho é insuficiente. Diante do exposto, a Biblioteca do Ministério da Justiça e Segurança Pública, no ano de 2018, contratou a APAE para realizar o trabalho de higienização e pequenos reparos de seu acervo, em especial o de Obras raras e Coleções Especiais, permitindo, de fato, a inclusão dos alunos da APAE-DF no mercado de trabalho. Assim, graças a parceria com a APAE-DF, a Biblioteca do Ministério da Justiça e Segurança Pública tornou concreta a inclusão da pessoa com necessidade especial cognitiva no ambiente de trabalho

Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial

OBJECTIVE: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage