Afferent Connections to the Rostrolateral Part of the Periaqueductal Gray: A Critical Region Influencing the Motivation Drive to Hunt and Forage

Previous studies have shown that a particular site in the periaqueductal gray (PAG), the rostrolateral PAG, influences the motivation drive to forage or hunt. To have a deeper understanding on the putative paths involved in the decision-making process between foraging, hunting, and other behavioral responses, in the present investigation, we carried out a systematic analysis of the neural inputs to the rostrolateral PAG (rlPAG), using Fluorogold as a retrograde tracer. According to the present findings, the rlPAG appears to be importantly driven by medial prefrontal cortical areas involved in controlling attention-related and decision-making processes. Moreover, the rlPAG also receives a wealth of information from different amygdalar, hypothalamic, and brainstem sites related to feeding, drinking, or hunting behavioral responses. Therefore, this unique combination of afferent connections puts the rlPAG in a privileged position to influence the motivation drive to choose whether hunting and foraging would be the most appropriate adaptive responses

What ethologically based models have taught us about the neural systems underlying fear and anxiety

Classical Pavlovian fear conditioning to painful stimuli has provided the generally accepted view of a core system centered in the central amygdala to organize fear responses. Ethologically based models using other sources of threat likely to be expected in a natural environment, such as predators or aggressive dominant conspecifics, have challenged this concept of a unitary core circuit for fear processing. We discuss here what the ethologically based models have told us about the neural systems organizing fear responses. We explored the concept that parallel paths process different classes of threats, and that these different paths influence distinct regions in the periaqueductal gray - a critical element for the organization of all kinds of fear responses. Despite this parallel processing of different kinds of threats, we have discussed an interesting emerging view that common cortical-hippocampal-amygdalar paths seem to be engaged in fear conditioning to painful stimuli, to predators and, perhaps, to aggressive dominant conspecifics as well. Overall, the aim of this review is to bring into focus a more global and comprehensive view of the systems organizing fear responses

Competências de liderança: ferramentas para a promoção da qualidade na assistência à saúde

Atualmente, a liderança compartilhada é tema de debate; significa delegar mais autonomia a pessoas que atuam em todos os níveis organizacionais, bem como dar- lhes a oportunidade de assumir um papel de sujeito transformador e de cidadão a fim de assumir a responsabilidade de direcionar suas ações em busca de objetivos já planejados. A estrutura da velha gestão dá lugar a estruturas mais flexibilizadas, mais horizontais e descentralizadas, gerando autonomia, pró-atividade e condições do indivíduo assumir a “dianteira”. O hospital não está à margem deste processo, e também vive um novo repensar de liderança. Neste sentido, tanto a Medicina quanto as demais áreas multiprofissionais de saúde tem assumido diferentes papéis dentro de suas atividades assistenciais ligadas ao paciente até a gerência de saúde, pensando não apenas em gerenciar com competências de liderança, mas também interar-se aos novos tempos e métodos, tornando-se audaciosa a partir de mecanismos como muita atenção e emoção, inteligência e auto-desenvolvimento para quebrar paradigmas de um perfil profissional. Este estudo buscou analisar as Competências de Liderança para a promoção da qualidade na assistência à saúde, a partir de Investigação Explicativa e Metanálise em unidade hospitalar, com 37 profissionais de saúde graduados e especializados

Tratamento farmacológico do Transtorno Depressivo Maior: uma revisão integrativa

Introdução: O Transtorno Depressivo Maior (TDM) caracteriza-se como um conjunto de sinais e sintomas tal como humor deprimido e/ou perda de interesse por atividades que eram prazerosas há, pelo menos, 2 semanas. Atualmente, segundo a Organização Pan-Americana de Saúde, tal transtorno é a principal causa de incapacidade no mundo e estima-se que mais de 300 milhões de pessoas, de todas as idades, sofram com essa patologia. Objetivo. Com base nesse panorama, o presente artigo busca avaliar se o mecanismo serotoninérgico de sinalização do TDM, apesar de ser o mais aceito, é o único existente. Além disso, busca-se analisar a eficácia da principal linha de tratamento para a depressão e a persistência de casos refratários. Método. Como metodologia, foi utilizada a busca por artigos nas principais bases de dados: PUBMED, LILACS e SCIELO. Resultados. Foram encontrados, após critérios de seleção, 36 artigos elegíveis para o estudo. Dentre os artigos selecionados, os anos de 2018 e 2021 foram os que mais se destacaram em relação à quantidade de publicações realizadas sobre esse transtorno, além disso, os Estados Unidos e Reino Unido lideraram o grupo de países publicadores. Conclusão. Dessa forma, apesar da via serotoninérgica ser a mais aceita no mecanismo de sinalização do TDM, há pacientes que apresentam recidiva ao tratamento. Logo, sob essa perspectiva, é primordial o aprofundamento e a compreensão dos demais mecanismos moleculares envolvidos no desencadeamento dos sintomas da doença para adotar-se linhas farmacológicas mais eficazes

PROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS DO ENVELHECIMENTO DA UNIVERSIDADE SÃO JUDAS TADEU: TRAJETÓRIA E PANORAMA ATUAL

O Programa de Pós-Graduação em Ciências do Envelhecimento (PGCE), nível mestrado, foi aprovado pela CAPES em 2009 e iniciou suas atividades em 2010. É o único programa de pós-graduação de uma universidade privada com foco em Gerontologia na cidade de São Paulo. Atualmente, o PGCE está organizado em uma área de concentração denominada Ciências do Envelhecimento e em três linhas de pesquisa: (1) Aspectos educacionais, psicológicos e socioculturais do envelhecimento; (2) Doenças associadas ao envelhecimento; e (3) Saúde e funcionalidade no envelhecimento. Esta revisão narrativa apresenta a descrição dos atuais projetos de pesquisa do PGCE, conforme apresentado no relatório para avaliação de 2017 a 2020, recentemente submetido à CAPES. No período acima referido, a produção científica do PGCE correspondeu a 331 produções: 54 artigos em periódicos, 15 capítulos de livros, 36 trabalhos em anais de congressos, 91 apresentações de trabalhos em congressos e 135 produções técnicas. Ao longo de sua trajetória, algumas mudanças destacaram as características interdisciplinares do PGCE, o que pode ser evidenciado pelo aumento: na qualidade dos artigos publicados, no número de alunos matriculados, de dissertações apresentadas e de projetos de pesquisa e extensão desenvolvidos no período de 2017 a 2020, em comparação com o período de 2013 a 2016. O PGCE é um programa dinâmico que se adapta às necessidades emergentes da sociedade, integra pesquisa e extensão e, ao mesmo tempo, apresenta uma produção robusta para a comunidade científica

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

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

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