A multidimensional program including standing exercises, health education, and telephone support to reduce sedentary behavior in frail older adults:Randomized clinical trial

Objectives: The primary aim of this study was to evaluate the effect of a multidimensional program including home-based standing exercises, health education, and telephone support for the reduction of sedentary behavior in community-dwelling frail older adults. The secondary aim of this study was to evaluate the safety and adherence of the program. Study design: A single-blind, randomized controlled trial. Methods: A total of 43 frail older adults were randomly assigned to the intervention and control groups. The intervention consisted of combined strategies including home-based standing exercises, health education, and telephone support for 16 weeks for frail older adults. The control group received orientation regarding the harmful effects of a sedentary lifestyle. Sedentary behavior was evaluated by total sedentary time, accumulated sedentary time in bouts of at least 10 min, and by the break in sedentary time, measured by an accelerometer used for at least 600 min/day for 4 days. Safety was assessed by self-reporting of possible adverse events. Adherence was assessed based on the number of days in which standing exercises were performed by the participants. Repeated measures ANOVA and Tukeys post hoc test were used to analyze the collected data. Results: The intervention group reduced the sedentary time by 30 min/day (p= 0.048), but without significant maintenance after 30 days of the program. Of the total number of participants, 82% (n = 14) of the intervention group participants showed more than 70% adherence to the program. The main adverse effects faced by the intervention group participants were tiredness (53%; n = 9) and lower limb pain (47%; n = 8). Conclusions: The multidimensional program reduced sedentary behavior, was safe, and showed satisfactory adherence in frail older adults

Prediction of intensive care admission and hospital mortality in COVID-19 patients using demographics and baseline laboratory data

Introduction: Optimized allocation of medical resources to patients with COVID-19 has been a critical concern since the onset of the pandemic. Methods: In this retrospective cohort study, the authors used data from a Brazilian tertiary university hospital to explore predictors of Intensive Care Unit (ICU) admission and hospital mortality in patients admitted for COVID-19. Our primary aim was to create and validate prediction scores for use in hospitals and emergency departments to aid clinical decisions and resource allocation. Results: The study cohort included 3,022 participants, of whom 2,485 were admitted to the ICU; 1968 survived, and 1054 died in the hospital. From the complete cohort, 1,496 patients were randomly assigned to the derivation sample and 1,526 to the validation sample. The final scores included age, comorbidities, and baseline laboratory data. The areas under the receiver operating characteristic curves were very similar for the derivation and validation samples. Scores for ICU admission had a 75% accuracy in the validation sample, whereas scores for death had a 77% accuracy in the validation sample. The authors found that including baseline flu-like symptoms in the scores added no significant benefit to their accuracy. Furthermore, our scores were more accurate than the previously published NEWS-2 and 4C Mortality Scores. Discussion and conclusions: The authors developed and validated prognostic scores that use readily available clinical and laboratory information to predict ICU admission and mortality in COVID-19. These scores can become valuable tools to support clinical decisions and improve the allocation of limited health resources

Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: A multicenter cohort study

Background: Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19. Methods: This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge. Results: Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality. Conclusion: The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality

A social and ecological assessment of tropical land uses at multiple scales: the Sustainable Amazon Network

Science has a critical role to play in guiding more sustainable development trajectories. Here, we present the Sustainable Amazon Network (Rede Amazonia Sustentavel, RAS): a multidisciplinary research initiative involving more than 30 partner organizations working to assess both social and ecological dimensions of land-use sustainability in eastern Brazilian Amazonia. The research approach adopted by RAS offers three advantages for addressing land-use sustainability problems: (i) the collection of synchronized and co-located ecological and socioeconomic data across broad gradients of past and present human use; (ii) a nested sampling design to aid comparison of ecological and socioeconomic conditions associated with different land uses across local, landscape and regional scales; and (iii) a strong engagement with a wide variety of actors and non-research institutions. Here, we elaborate on these key features, and identify the ways in which RAS can help in highlighting those problems in most urgent need of attention, and in guiding improvements in land-use sustainability in Amazonia and elsewhere in the tropics. We also discuss some of the practical lessons, limitations and realities faced during the development of the RAS initiative so far.Keywords: Social–ecological systems, Tropical forests, Land use, Interdisciplinary research, Sustainability, Trade-off

The psychiatrist and the artisti : Nise da Silveira and Almir Mavignier meet the images of the unconscious

Orientador: Lucia Helena ReilyDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de ArtesResumo: O objetivo desta pesquisa foi investigar os primeiros anos (de 1946 a 1957) do ateliê de pintura - localizado no hospital psiquiátrico do Engenho de Dentro, no Rio de Janeiro, Brasil - do ponto de vista dos artistas plásticos envolvidos, bem como a sua repercussão no campo da arte. Os dados foram coletados por meio de entrevistas com pessoas que participaram do início deste ateliê, análise de gravações em vídeo do acervo do Museu de Imagens do Inconsciente, revisão bibliográfica, incluindo consulta a jornais e revistas da época para reconstruir um panorama histórico sobre o ateliê de pintura. A literatura já mostrou como a psiquiatra Nise da Silveira, uma das mais importantes personalidades femininas do século passado no Brasil, associou-se ao jovem artista Almir Mavignier para criar um ateliê que usava a arte como recurso terapêutica no tratamento de um grupo de internos do hospital psiquiátrico. O presente estudo buscou reconstituir partes ignoradas desta história: como os internos foram convidados a freqüentar o ateliê, a atuação de Mavignier no desenvolvimento das atividades de arte, como se deu a confluência de outros artistas ao Engenho de Dentro, instigados pela produção plástica dos pacientes psiquiátricos e a organização de exposições em espaços culturais bem como em eventos de saúde mental. A produção plástica realizada neste ateliê, que deu origem ao Museu de Imagens do Inconsciente, ganhou notoriedade entre os críticos de arte da época, sendo exposta em importantes museus, como o Museu de Arte Moderna de São Paulo. Este estudo buscou mostrar os processos por meio dos quais os críticos tiveram contato com o trabalho. As obras do Museu de Imagens do Inconsciente foram reconhecidas internacionalmente por personalidades como C. G. Jung e Albert Camus. A produção plástica realizada neste ateliê também teve ressonância em artistas contemporâneos como Francisco Brennand, Ivan Serpa e Abraham Palatnik, que visitaram este ateliê. O estudo sugere que o fato de um artista plástico desenvolver os trabalhos no ateliê no contexto psiquiátrico representa um diferencial nos resultados. Concluímos que este ateliê de pintura faz parte do mosaico da história da arte no Brasil e que seu estudo mais sistemático nas diversas fases pode trazer contribuições para reflexões interdisciplinares nos campos da arte, saúde mental, e educaçãoAbstract: This study aimed to investigate the early years (from 1946 to 1957) of the art studio of the Engenho de Dentro Psychiatric Hospital in Rio de Janeiro, Brazil, from the point of view of the artists involved in the project, as well as its repercussions in the art world in Rio and São Paulo. Data was collected through interviews with participants who worked during the first years of the studio, analysis of video recordings from files owned by the Museu de Imagens do Inconsciente, and review of the literature, including research into articles published in newspapers and magazines of the period, all of which helped to reconstruct a historical ambience for this painting studio. Publications have shown how Nise da Silveira, psychiatrist, one of the most important Brazilian female figures of the last century, became associated with Almir Mavignier, visual artist, who together created the studio where art was to be used as a therapeutic resource for treating a group of patients at the psychiatric facility. The present study attempted to reconstruct unknown parts of this story: how eleven patients were chosen and invited to go to the studio, Mavignier's way of proposing and organizing art activities, how other visual artists began to flock to the Engenho de Dentro instigated by the artistic production of the psychiatric patients, and the organization of exhibits in culture centers, as well as mental health conferences. The visual arts products that came out of this studio, which gave way to the renowned Museu de Imagens do Inconsciente, began to intrigue art critics, and were exhibited in major museums, such as the Museum of Modem Art in São Paulo. This study aimed to show the processes whereby the critics came into contact with the work of psychiatric patients and their role in divulging these images." The production of the Museu de Imagens do Inconsciente was recognized internationally by people such as C. G. Jung and Albert Camus. There was also significant response from contemporary Brazilian artists such as Francisco Brennand, Ivan Serpa and Abraham Palatnik, all of whom visited the studio. This study suggests that the fact that a visual artist headed the work done at the studio in the psychiatric environment affected the results in important ways. We conclude that this painting studio is part of the mosaic of Brazilian art history and that a thorough study of the various phases in the history of the studio will bring important contributions to interdisciplinary thinking in the fields of art, mental health and educationMestradoMestre em Arte

The art of Nise da Silveira's occupational therapy

Orientador: Lúcia Helena ReilyTese (doutorado) - Universidade Estadual de Campinas, Instituto de ArtesResumo: Esta pesquisa discute a teoria e a técnica da terapêutica ocupacional da psiquiatra Nise da Silveira, pioneira no Brasil no estudo das atividades expressivas, artísticas e de atividade como meio de terapia em pessoas com doença mental. Defende-se a tese que ela criou a sua própria terapêutica ocupacional ao invés de se filiar a alguma escola de terapia ocupacional já existente. Busca-se neste estudo reconstruir a trajetória de Nise da Silveira e encontrar evidências que recuperem seu modo de estudo e prática da terapêutica ocupacional. A metodologia utilizada é a qualitativa e privilegia as fontes primárias. Destacaram-se para análise duas fontes: uma entrevista concedida a pesquisadora Dulce Pandolfi em 1992 utilizando a história oral para reconstruir parte de sua trajetória e um filme inédito de 1986 feito pelo cineasta Leon Hirszman em que a psiquiatra discute as questões ligadas à reforma psiquiátrica e a terapêutica ocupacional/ "emoção de lidar". Além de entrevistas, foram analisados artigos de jornais e material escrito da psiquiatra. A pesquisa apoia-se em uma iconologia que mostra Nise da Silveira e a terapêutica ocupacional desenvolvida por ela. Outro ponto importante deste trabalho foi explicitar a própria metodologia de pesquisa utilizada por ela, bem como aproximar-se do seu pensamento por meio do estudo da sua biblioteca e os autores que ela escolhe para fundamentar sua teoria sobre a terapêutica ocupacional com ênfase nas atividades expressivas. A discussão biográfica e de sua produção escrita pontua que Nise da Silveira estudou e praticou terapia ocupacional no Brasil, dez anos antes de termos o primeiro curso reconhecido nos textos atuais da história desta profissão. Esta pesquisa contribui para a interseção das áreas de artes plásticas e de terapia ocupacional. Conclui-se que Nise da Silveira, além de várias outras áreas em que atuou, deixou um legado significativo para o diálogo entre campos como arte e saúde considerando principalmente o atendimento de pessoas com sofrimento mentalAbstract: This study discusses Nise da Silveira's theoretical approach and her occupational therapy technique. This psychiatrist was a pioneer in the study of expressive, artistic and work activities as a means of therapy for people with mental illness. I defend the thesis that Silveira created her own brand of occupational therapy, rather than seeking affiliation to an already existing occupational therapy school of thought. In this study I aim to reconstruct Nise da Silveira's trajectory and find evidence that recovers the way in which she studied and practiced in occupational therapy. The main sources of discourse that were analyzed included an interview given to Dulce Pandolfi in 1992 using the oral history method to reconstruct part of her trajectory and an unfinished film that Leon Hirszman produced in 1986 in which Nise da Silveira discussed issues related to psychiatry reform and occupational therapy / "emotion of coping". Besides the interviews, Nise da Silveira left various articles in journals, published books and many other manuscripts which were read and analyzed. This study uses iconology to present Nise da Silveira and the occupational therapy that she developed. Another important issue was to make her research methodology explicit, as well as to understand her thinking by looking at her library and chosen authors that underlie her theoretical stance on occupational therapy and on expressive arts activities. The discussion of biographical information and of her written production highlights that Nise da Silveira studied and practiced occupational therapy in Brazil ten years before the first university level course had been recognized, according to present day texts on the history of the profession. This study contributes towards the intersection of the fields of visual arts and occupational therapy. The conclusion is that Nise da Silveira, who crossed into various fields of knowledge, left a significant heritage to enable dialogue between professionals in the fields of art and health, primarily for the benefit of services for people with mental sufferingDoutoradoArtes VisuaisDoutor em Arte

An evaluation of binge eating characteristics in individuals with eating disorders : a systematic review and meta-analysis

The objective of this review is to provide an updated synthesis of studies in individuals with eating disorders that examined the following components of binge eating episodes (BEEs): caloric intake, episode duration, and also the association of BEE size with psychopathology. A systematic review and meta-analysis were performed following the PRISMA guidelines. Searches were conducted on PubMed, PsycINFO, Scopus, SciELO, ScienceDirect and ProQuest databases. Meta-analysis was performed using random effects models and meta-regression. Forty-three studies were included. There was a paucity of information regarding BEE in individuals with anorexia nervosa. The pooled caloric intake of participants with bulimia nervosa (BN) during BEE in laboratory studies was significantly greater in comparison to the caloric intake during BEE in clinical studies [(3070 (95%CI 2596, 3544) vs. 1789 (95%CI 1498, 2081)], respectively. In participants with binge eating disorder (BED), the pooled means were 2088 (95%CI 1819, 2358) kcal in laboratory studies and 1903 (95%CI 1622, 2184) kcal in clinical studies, with no statistically significant difference between groups. Overall, BEE had a mean duration of 37.3 min in participants with BN and 41.7 min in those with BED. We found a positive correlation between the average caloric intake and level of depression (β = 55.5; p = 0.019). BEE in individuals with BN or BED were characterized by the consumption of extremely large quantities of calories. This was mainly found in laboratory studies of individuals with BN. BEE had a mean duration of less than 1 h in individuals with BN or BED. BEE size was positively associated with depression severity. Future research should explore the relevance of binge size as a core component of binge eating in clinical samples, in males, and in pediatric populations

A social and ecological assessment of tropical land uses at multiple scales:the Sustainable Amazon Network

Science has a critical role to play in guiding more sustainable development trajectories. Here, we present the Sustainable Amazon Network (Rede Amazonia Sustentavel, RAS): a multidisciplinary research initiative involving more than 30 partner organizations working to assess both social and ecological dimensions of land-use sustainability in eastern Brazilian Amazonia. The research approach adopted by RAS offers three advantages for addressing land-use sustainability problems: (i) the collection of synchronized and co-located ecological and socioeconomic data across broad gradients of past and present human use; (ii) a nested sampling design to aid comparison of ecological and socioeconomic conditions associated with different land uses across local, landscape and regional scales; and (iii) a strong engagement with a wide variety of actors and non-research institutions. Here, we elaborate on these key features, and identify the ways in which RAS can help in highlighting those problems in most urgent need of attention, and in guiding improvements in land-use sustainability in Amazonia and elsewhere in the tropics. We also discuss some of the practical lessons, limitations and realities faced during the development of the RAS initiative so far