Revisando a prevenção da pré-eclâmpsia com aspirina em baixa dose: uma revisão sistemática dos principais estudos randomizados controlados

The purpose of this paper is to evaluate the effectiveness of low-dose aspirin in the prevention of preeclampsia in low-risk and high-risk women. We identified randomized clinical trials of the use of low-dose aspirin to prevent preeclampsia through the PUBMED search engine, and through the Cochran Library database. Twenty-two studies met our inclusion criteria, and were divided according to the studied population into 2 groups: trials with women at low risk for preeclampsia and trials with women at high risk. Effects were measured through the incidence of preeclampsia in women taking either placebo or aspirin, in studies where the relative risks and the 95% confidence intervals were calculated for both groups. A total of 33,598 women were studied, comprising 5 trials with 16,700 women at low-risk and 17 trials including 16,898 women at high risk. The incidence of preeclampsia was 3.75% (626/17,700), in the low-risk group, 9.01% (1,524/16,898) in the high-risk group, and 6.40% (2,150/33,598) overall. Low-dose aspirin had no statistically significantly effect on the incidence of preeclampsia in the low-risk group (RR = 0.95, 95% CI = 0.81-1.11), but had a small beneficial effect in the high-risk group (RR = 0.87, 95% CI = 0.79-0.96). Therefore, low-dose aspirin is mildly beneficial in terms of reducing the incidence of preeclampsia in women at high risk of developing preeclampsia.Esta revisão busca reúne estudos sobre a eficácia da aspirina em baixas doses na prevenção da pré-eclâmpsia em pacientes de alto e baixo risco. Identificamos estudos clínicos randomizados controlados usando baixas doses de aspirina para prevenir a pré-eclâmpsia, publicados no MEDLINE. Vinte e dois estudos preencheram nossos critérios de inclusão. Dividimos os estudos de acordo com a população estudada em dois grupos: estudos com mulheres de baixo risco para pré-eclâmpsia e estudos com pacientes de alto risco. A principal medida de efeito foi a incidência de pré-eclâmpsia em pacientes que usaram placebo ou aspirina, na qual os riscos relativos e os intervalos de confiança de 95% foram calculados para os grupos de pacientes de baixo e de alto risco para pré-eclâmpsia. Um total de 33.598 pacientes foram estudadas, dentre as quais cinco estudos com 16.700 pacientes de baixo risco e 17 estudos incluindo 16.898 pacientes de alto risco. As incidências de pré-eclâmpsia no geral, no grupo de baixo e no de alto risco foram de 6,40% (2.150/33.598), 3,75% (626/17.700), e 9,01% (1.524/16.898), respectivamente. Baixas doses de aspirina não tiveram efeito estatístico significante na redução da incidência de pré-eclâmpsia em pacientes de baixo risco (RR=0.95, 95%CI = 0.81-1.11), porém apresentaram pequenos benefícios em mulheres de alto risco (RR=0.87, 95%CI=0.79-0.96). Esta análise leva à conclusão de que baixas doses de aspirina têm pequeno efeito na redução da incidência da pré-eclâmpsia em pacientes com alto risco de desenvolver a doença

FLAG review 2019: Flavour lattice Averaging Group (FLAG)

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UA

One-year regional brain volume changes as potential predictors of cognitive function in multiple sclerosis: a pilot study

BackgroundThe most reliable magnetic resonance imaging (MRI) marker of cognitive dysfunction in multiple sclerosis (MS) is brain atrophy. However, 1-year volumetric changes prior to cognitive assessment were never studied as potential predictors of cognition, which we aim to assess with this pilot work.MethodsTwenty-two MS patients were submitted to a baseline measure of 83 regional brain volumes with MRI and re-evaluated 1 year later; they were also tested with the Brief International Cognitive Assessment for MS (BICAMS): sustained attention and processing speed were examined with the Symbol Digit Modalities Test (SDMT), verbal and visuo-spatial learning and memory with the learning trials from the California Verbal Learning Test-II (CVLT) and the Brief Visuo-spatial Memory Test-revised (BVMT), respectively. Controlling for age, sex, and years of education, a multivariate linear regression model was created for each cognitive score at 1-year follow-up in a backward elimination manner, considering cross-sectional regional volumes and 1-year volume changes as potential predictors.ResultsDecreases in the volumes of the left amygdala and the right lateral orbitofrontal cortex in the year prior to assessment were identified as possible predictors of worse performance in verbal memory (P = 0.009) and visuo-spatial memory (P = 0.001), respectively, independently of cross-sectional brain regional volumes at time of testing.ConclusionOur work reveals novel 1-year regional brain volume changes as potential predictors of cognitive deficits in MS. This suggests a possible role of these regions in such deficits and might contribute to uncover cognitively deteriorating patients, whose detection is still unsatisfying in clinical practice.Open access funding provided by FCT|FCCN (b-on). Biogen, Fundacao para a Ciencia e Tecnologia, UIDB/50026/2020, Fundacao para a ciencia e tecnologia, UIDP/50026/2020, Fundacao para a Ciencia e a Tecnologia, EXPL/MEC-NEU/0888/2021, Torcato Meira

Editorial: performance analysis in sport

Performance analysis is a sub-discipline of Sport Science research (Borms, 2008) that has attained great interest for many stakeholders (i.e., coaches, technical staff, performance analysts, managers, media, fans, and players) at different levels of performance (i.e., youth, semiprofessional, or professional players). The development and implementation of new technologies to measure individual or team’s performances (e.g., tracking systems such as local positioning systems, LPS; video tracking, or observational video analysis systems) with multiple practical applications have intensified the focus of performance analysis in sport (Hughes and Franks, 2007). Traditional approaches have included static analysis focused on retrospective performances; however, dynamic and complex analyses (i.e., non-linear Multi-Dimensional Scaling, classification and regression tree, logistic regression, etc.) have become increasingly utilized by researchers for a deeper understanding of sport performance during training and competition (O’Donoghue, 2009). In particular, a holistic and multidisciplinary perspective such as the Grand Unified Theory analyses (GUT, see Glazier, 2017) has been suggested to be fundamental for sports performance. This approach, provides a framework to examine the inter- and intra-athlete’s behavior dimensions under the environmental and task-related (ecological) factors that affect the performance. Specifically, isolated approaches have been suggested to be avoided with the integration of the biomechanical, physiological, psychological, technical, tactical, positional, motor development and/or strength and conditioning perspectives recommended when evaluating match-related contexts and training tasks (Glazier, 2017). Additionally, Woods et al. (2020) highlighted the importance of ecological dynamics to guide the control, preparation and assessment of athletes and teams. Subsequently, the use of interdisciplinary research designs would provide clear and well-described rationales, powerful data collection and analyses, resulting in robust findings. Innovative sports performance analyses that incorporate new technologies to understand individual’s behaviors within real-based and ecological contexts would provide a greater understanding of how players and teams act and react for greater performance development and application (Bertollo et al., 2020). In fact, as Robertson (2020) argued, the development of professionalism and data gathering in sport had lead to a new scenario for coaching staff, athletes, and performance analysts where adaptative tools are essentially required to understand the needs of sports performance (e.g., human-machine interaction, perspective, innovation, versatility, visualization, evaluation, feedback, generalization, and future planning

Finding positive health in “fortalezas” and “comunidad”: A case study of Latinos/X in Sonoma Valley

Background: Psychological literature and needs-assessment reports emphasize that Latinos/X in Sonoma Valley continue to be impacted by the detrimental effects of the 2017 Northern California wildfires (Domínguez & Yeh, 2018), current immigration enforcement practices, higher rates of poverty, lower educational attainment, persistent barriers to health care access, and obstacles to proportionate leadership representation compared to White American families. To cope with these disparities and navigate life adversities, Sonoma Valley Latinos/X often rely on “fortalezas” [strengths] and community, political, spiritual, cultural, and physical assets. These assets, which often include meaningful interactions with family, friends, neighbors, folk healers, faith-based organizations, and community members, must be incorporated when health care, community, and social service initiatives are designed and implemented. Method: Our community-engaged research team (CERT) used asset-based community development (ABCD) as a conceptual framework (Kretzmann & McKnight, 1993) and community-based participatory research (CBPR) (Wallerstein & Duran, 2003) as a methodological approach to explore the assets and “fortalezas” [strengths] that have enabled Latinos/X to overcome adverse experiences i n Sonoma Valley. Five focus groups and 29 in-depth interviews were conducted because these methods are well-suited for Latino/X relational styles of “platicando” [small talk] (Delgado-Romero, Singh, & De Los Santos, 2018) . Participants were 18 years or older, lived or worked i n Sonoma Valley, and self-identified as Latino/X. Our sample included Latino/X parents, grandparents, artists, folk healers, health and social service providers, community leaders, students, and school personnel. Specific locations where interviews took place include the Hanna Institute, Nuestra Voz, La Luz Center, Center for Well-Being, Boys and Girls Clubs of Sonoma Valley, the Family Resource Center in El Verano, the Sonoma Valley Community Health Center, participants’ houses, and the broader Sonoma Valley community. Our research prioritized depth of relational engagement rather than sample size (Bowden, Caine, Yohani, 2017). We discontinued data collection once our research objectives were achieved and data saturation was accomplished. For data analysis, we used quasi-statistics to quantify the frequency of asset endorsement; open, axial, and selective coding to identify and categorize the assets; and GIS software for the creation of our two asset maps. Findings: Findings indicate that Latinos/X are marginally positioned within Sonoma Valley society. Latinos/X have coped with and adapted to adverse conditions and disparities using and relying on a variety of informal networks and formal sources of support. Their decision to rely on one source of support over another is often based on (a) the extent to which they can afford the services or support required; (b) their particular needs, goals, or objectives at the time the help i s needed; (c) their preference for support resources that honor “respeto” [respect], “personalismo” [a preference for close personal attention i n relationships], and stable and welcoming intimate relationships with others; (d) the accessibility associated with pursuing these support services (e.g., geographic and transportation limitations); and (e) the extent to which culturally relevant and Spanish-speaking support can be found. Dissemination: All data i n this study i s co-owned with the Sonoma Valley community. With the help of our community partners, this report was disseminated in Sonoma Valley during community meetings and forums, offering residents the opportunity to provide feedback, debate preliminary results, and assess whether their voices were captured accurately. Once the community expressed that the findings were representative of the Latino/X experience in Sonoma Valley, we finalized recommendations to assist community members, government officials, and health care and social service providers in designing culturally informed social, health, and/or community programs

Ultrasound Detects Subclinical Joint Inflammation in the Hands and Wrists of Patients With Systemic Lupus Erythematosus Without Musculoskeletal Symptoms

OBJECTIVES: To assess the prevalence and severity of ultrasonographic abnormalities of the hand and wrist of asymptomatic patients with systemic lupus erythematosus (SLE) and compare these findings with those from patients with SLE with musculoskeletal signs or symptoms and healthy controls. METHODS: We conducted a prospective cross-sectional study that evaluated bilaterally, with grey-scale and power Doppler (PD) ultrasound (US), the dorsal hand (2nd to 5th metacarpophalangeal and 2nd to 5th proximal interphalangeal joints) and wrist (radiocarpal, ulnocarpal and intercarpal joints) of 30 asymptomatic patients with SLE, 6 symptomatic patients with SLE and 10 controls. Synovial hypertrophy (SH) and intra-articular PD signal were scored using semiquantitative grading scales (0-3). Individual scores were graded as normal (SH≤1 and PD=0) or abnormal (SH≥2 or PD≥1). Global indexes for SH and PD were also calculated. US findings were correlated with clinical and laboratory data and disease activity indexes. RESULTS: US detected SH (score ≥1) in 77% asymptomatic patients with SLE, mostly graded as minimal (score 1: 63%). 23% of the asymptomatic patients with SLE showed abnormal US PD findings (SH≥2 or PD≥1). SH was present in all symptomatic patients with SLE, mostly graded as moderate (grade 2: 67%), and with associated PD signal (83%). SH (score 1) was identified in 50% of controls, however, none presented abnormal US PD findings. SH index in the asymptomatic SLE group was higher than in the control group (2.0 (0-5) vs 0.5 (0-2), median (range), p=0.01) and lower than in the symptomatic SLE group (7.0 (4-23), median (range), p<0.001). No significant correlation was demonstrated between US PD findings and clinical or laboratory variables and disease activity indexes. CONCLUSION: A small subgroup of asymptomatic patients with SLE may present subclinical joint inflammation. Global US scores and PD signal may be important in disease evaluation and therapeutic monitoring.info:eu-repo/semantics/publishedVersio

Thoracic Manifestations of Connective Tissue Diseases

Connective tissue diseases (CTDs) comprise several immunologic systemic disorders, each of which associated with a particular set of clinical manifestations and autoimmune profile. CTDs may cause numerous thoracic abnormalities, which vary in frequency and pattern according to the underlying disorder. The CTDs that most commonly involve the respiratory system are progressive systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, Sjögren syndrome, polymyositis, dermatomyositis, and mixed connective tissue disease. Pulmonary abnormalities in this group of patients may result from CTD-related lung disease or treatment complications, namely drug toxicity and opportunistic infections. The most important thoracic manifestations of CTDs are interstitial lung disease and pulmonary arterial hypertension, with nonspecific interstitial pneumonia being the most common pattern of interstitial lung disease. High-resolution computed tomography is a valuable tool in the initial evaluation and follow-up of patients with CTDs. As such, general knowledge of the most common high-resolution computed tomographic features of CTD-related lung disease allows the radiologist to contribute to better patient management

From knowing our needs to enacting change: findings from community consultations with indigenous communities in Bangladesh

Introduction: Indigenous peoples are among the most marginalized peoples in the world due to issues relating to well-being, political representation, and economic production. The research consortium Goals and Governance for Global Health (Go4Health) conducted a community consultation process among marginalized groups across the global South aimed at including their voices in the global discourse around health in the post-2015 development agenda. This paper presents findings from the consultations carried out among indigenous communities in Bangladesh. Methods: For this qualitative study, our research team consulted the Tripura and Mro communities in Bandarban district living in the isolated Chittagong Hill Tracts region. Community members, leaders, and key informants working in health service delivery were interviewed. Data was analyzed using thematic analysis. Findings: Our findings show that remoteness shapes the daily lives of the communities, and their lack of access to natural resources and basic services prevents them from following health promotion messages. The communities feel that their needs are impossible to secure in a politically indifferent and sometimes hostile environment. Conclusion: Communities are keen to participate and work with duty bearers in creating the conditions that will lead to their improved quality of life. Clear policies that recognize the status of indigenous peoples are necessary in the Bangladeshi context to allow for the development of services and infrastructure.publishedVersio