A eficácia do treinamento auditivo na fluência da leitura / The effectiveness of auditory training in reading fluency

Uma leitura de qualidade representa a oportunidade de ampliar a visão do mundo e muitas habilidades estão envolvidas nesse processo, caso estejam alteradas interferem na fluência leitora. O treinamento auditivo promove estratégias utilizadas para desenvolver ou reabilitar habilidades auditivas alteradas. O objetivo deste trabalho foi relatar a importância da fluência leitora e a relevância do treinamento auditivo para indivíduos com alterações na aprendizagem, tendo como dificuldade a fluência da leitura. Apresentando um estudo de caso de um indivíduo do sexo masculino, 09 anos de idade, com transtorno de desenvolvimento da linguagem e comorbidade com TDAH. O método utilizado foi o treinamento auditivo musical, sendo aprovado pelo comitê de ética e pesquisa (CEP) com 12 sessões sendo uma vez por semana presencialmente e diariamente em casa como atividade reforço. O resultado foi considerado satisfatório. Não houve melhora na fluência, porém o indivíduo apresentou menos trocas, omissões e adições de letras e fonemas, assim como obteve melhora na prosódia e compreensão

Effect of Dysglycemia on Urinary Lipid Mediator Profiles in Persons With Pulmonary Tuberculosis

Background: Oxidized lipid mediators such as eicosanoids play a central role in the inflammatory response associated with tuberculosis (TB) pathogenesis. Diabetes mellitus (DM) leads to marked changes in lipid mediators in persons with TB. However, the associations between diabetes-related changes in lipid mediators and clearance of M. tuberculosis (Mtb) among persons on anti-TB treatment (ATT) are unknown. Quantification of urinary eicosanoid metabolites can provide insights into the circulating lipid mediators involved in Mtb immune responses. // Methods: We conducted a multi-site prospective observational study among adults with drug-sensitive pulmonary TB and controls without active TB; both groups had sub-groups with or without dysglycemia at baseline. Participants were enrolled from RePORT-Brazil (Salvador site) and RePORT-South Africa (Durban site) and stratified according to TB status and baseline glycated hemoglobin levels: a) TB-dysglycemia (n=69); b) TB-normoglycemia (n=64); c) non-TB/dysglycemia (n=31); d) non-TB/non-dysglycemia (n=29). We evaluated the following urinary eicosanoid metabolites: 11α-hydroxy-9,15-dioxo-2,3,4,5-tetranor-prostane-1,20-dioic acid (major urinary metabolite of prostaglandin E2, PGE-M), tetranor-PGE1 (metabolite of PGE2, TN-E), 9α-hydroxy-11,15-dioxo-2,3,4,5-tetranor-prostane-1,20-dioic acid (metabolite of PGD2, PGD-M), 11-dehydro-thromboxane B2 (11dTxB2), 2,3-dinor-6-keto-PGF1α (prostaglandin I metabolite, PGI-M), and leukotriene E4 (LTE4). Comparisons between the study groups were performed at three time points: before ATT and 2 and 6 months after initiating therapy. // Results: PGE-M and LTE4 values were consistently higher at all three time-points in the TB-dysglycemia group compared to the other groups (p<0.001). In addition, there was a significant decrease in PGI-M and LTE4 levels from baseline to month 6 in the TB-dysglycemia and TB-normoglycemia groups. Finally, TB-dysglycemia was independently associated with increased concentrations of PGD-M, PGI-M, and LTE4 at baseline in a multivariable model adjusting for age, sex, BMI, and study site. These associations were not affected by HIV status. // Conclusion: The urinary eicosanoid metabolite profile was associated with TB-dysglycemia before and during ATT. These observations can help identify the mechanisms involved in the pathogenesis of TB-dysglycemia, and potential biomarkers of TB treatment outcomes, including among persons with dysglycemia

Healthy people with nature in mind

This is the final version of the article. Available from the publisher via the DOI in this record.BACKGROUND: The global disease burden resulting from climate change is likely to be substantial and will put further strain on public health systems that are already struggling to cope with demand. An up- stream solution, that of preventing climate change and associated adverse health effects, is a promising approach, which would create win-win-situations where both the environment and human health benefit. One such solution would be to apply methods of behaviour change to prompt pro-environmentalism, which in turn benefits health and wellbeing. DISCUSSION: Based on evidence from the behavioural sciences, we suggest that, like many social behaviours, pro- environmental behaviour can be automatically induced by internal or external stimuli. A potential trigger for such automatic pro-environmental behaviour would be natural environments themselves. Previous research has demonstrated that natural environments evoke specific psychological and physiological reactions, as demonstrated by self-reports, epidemiological studies, brain imaging techniques, and various biomarkers. This suggests that exposure to natural environments could have automatic behavioural effects, potentially in a pro-environmental direction, mediated by physiological reactions. Providing access and fostering exposure to natural environments could then serve as a public health tool, together with other measures, by mitigating climate change and achieving sustainable health in sustainable ecosystems. However, before such actions are implemented basic research is required to elucidate the mechanisms involved, and applied investigations are needed to explore real world impacts and effect magnitudes. As environmental research is still not sufficiently integrated within medical or public health studies there is an urgent need to promote interdisciplinary methods and investigations in this critical field. Health risks posed by anthropogenic climate change are large, unevenly distributed, and unpredictable. To ameliorate negative impacts, pro-environmental behaviours should be fostered. Potentially this could be achieved automatically through exposure to favourable natural environments, with an opportunity for cost-efficient nature-based solutions that provide benefits for both the environment and public health

INFLUÊNCIA DA OBESIDADE SARCOPÊNICA NO RISCO DE QUEDAS EM IDOSOS: UMA REVISÃO SISTEMÁTICA

Aim. To assess the influence of Sarcopenic Obesity (SO) on the risk of falls among the elderly, showing the impact of this association on the quality of life, health and autonomy of this population. Methods. This is a systematic review in which ​​studies indexed in the Pubmed, Scopus and BVS databases were searched using the descriptors (Sarcopenia AND Obesity OR Sarcopenic Obesity) AND (Elderly OR Elderly OR Elderly) AND (Accidental falls).Were read from the articles: title and abstract. Duplicates, articles that do not fit the proposed objective, literary reviews, books, conference abstracts and editorials, as well as publications prior to 2014 were eliminated. Two independent reviewers assessed the studies eligibility. The full text version was read if at least one of the reviewers considered the study eligible. Data was independently extracted from each study by the authors. Results. A total of ten studies met the criteria to be included in this review, comprehending a total of 22,418 participants and their respective data. The prevalence of falls in patients with SO varied between 29.47% and 60.53%, the Odds Rattio between the risk of falls and the defining components of SO varied between 1.05 and 2.64. Conclusions. A relationship between SO cases and the increase in the number of falls was noted from the selected studies, showing a change in the quality of life of the elderly and a possible increase in morbidity and mortality.Objetivo: Avaliar a influência da obesidade sarcopênica (OS) no risco de quedas em pessoas idosas, evidenciando o impacto dessa associação na qualidade de vida, saúde e autonomia dessa população. Métodos: Trata-se de uma revisão sistemática, na qual foram pesquisados estudos indexados nas bases PubMed, Scopus e BVS a partir dos descritores (Sarcopenia AND Obesity OR Sarcopenic obesity) AND (Aged OR Elderly OR Older people) AND (Accidental falls). Foram lidos o título e o resumo dos artigos. Duplicidades, artigos que não se adequaram ao objetivo proposto, revisões literárias, livros, resumos de conferências e editoriais, bem como publicações anteriores a 2014, foram eliminados. Dois revisores avaliaram independentemente a elegibilidade dos estudos. A versão completa do texto foi lida se pelo menos um dos revisores considerasse o estudo elegível. Os dados foram extraídos de cada estudo de forma independente pelos autores. Resultados: Dez estudos contemplaram os critérios para serem incluídos nesta revisão, compreendendo um total de 22.418 participantes e seus respectivos dados. A prevalência de quedas em pacientes com OS variou entre 29,47% e 60,53%, e o Odds Ratio entre o risco de quedas e os componentes definidores de OS variou entre 1,05 e 2,64. Conclusão: Notou-se uma relação significativa entre os casos de OS e o aumento do número de quedas a partir dos estudos selecionados, evidenciando uma alteração na qualidade de vida dos idosos e possível aumento de morbimortalidade

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

COVID-19 Vaccine Hesitancy Among PLWH in South India: Implications for Vaccination Campaigns.

BackgroundThe global effort to end the Severe Acute Respiratory Syndrome - Coronavirus 2 pandemic will depend on our ability to achieve a high uptake of the highly efficacious vaccines in all countries. India recently experienced an unprecedented transmission surge, likely fueled by a premature reopening, the highly transmissible delta variant, and low vaccination rates. Indian media have reported high degrees of vaccine hesitancy, which could interfere with efforts to prevent future surges, making it crucial to better understand the reasons for such reluctance in vulnerable populations, such as people living with HIV.MethodsWe conducted telephone interviews with 438 people living with HIV who were participants in a longitudinal cohort, designed to examine and validate novel antiretroviral therapy ART adherence measures. Interviews were conducted in January and February 2021 and covered COVID-19-related questions on confidence in vaccine safety and efficacy, worries of vaccine side effects, trust in COVID-19 information from specific sources, and intent to get vaccinated.ResultsOver one-third of participants (38.4%, n = 168) met our definition of "vaccine hesitant" by reporting being either unlikely to get vaccinated at all or wanting to wait. Vaccine hesitancy was associated with lack of confidence in vaccine safety, concerns about side effects and efficacy, and distrust in common sources of vaccine-related information.DiscussionThese results highlight several challenges for vaccination efforts. Campaigns may benefit from using trusted sources, including antiretroviral therapy center staff, providing clear information about safety and efficacy and emphasizing the role of vaccines in preventing severe disease, hospitalizations and death, and the reduction of forward transmission to unvaccinated household members

Reducing HIV stigma among healthcare providers in India using a partly tablet-administered intervention: the DriSti trial

HIV stigma has long been recognized as a significant barrier in the worldwide fight against HIV. Across cultures, stigma has been shown to cause psychological distress and act as a barrier to engagement in care. Health professionals can serve as a crucial source of HIV stigma, with drivers that include fears and transmission misconceptions and pre-existing negative attitudes towards marginalized groups. To increase their impact, stigma reduction interventions need to be scalable and sustainable as well as adaptable to different cultural contexts. The DriSti intervention was designed to meet these needs through an easily adaptable, mostly tablet-administered, interactive intervention delivered to ward staff (n = 1,557) and nursing students (n = 1,625) in 62 Indian institutions, using a cRCT design, with wait-list controls. Six-month outcome analyses, showed significant reductions in misconceptions (p &lt; .001) and worry about acquiring HIV at work (p &lt; .001). Intervention participants also reported significantly greater reductions in endorsement of coercive policies (p &lt; .001) and in the number of situations in which they intended to discriminate against PLWH (p &lt; .001) than control participants. This brief, scaleable intervention could be adapted for similar populations in the region, using different mHealth platforms and thus has important implications for current global stigma reduction initiatives and training curricula