Atividade física como instrumento de educação popular em saúde

OBJETIVO: Mostrar a atividade física em grupo como instrumento de Educação Popular em Saúde. MÉTODOS: Relato de experiência de atividade física coletiva em idosos como instrumento de Educação Popular em Saúde. Acontece na Unidade de Saúde Dr. Antônio Benício Freire da Silva. O projeto de flexibilidade e exercícios funcionais iniciou em 2014. Acontece duas vezes por semana, com duração de uma hora, com uma média de 18 participantes. As sessões seguem um roteiro predefinido com aquecimento, exercícios Funcionais e de Força e finaliza com a volta calma. Os materiais utilizados são garrafinhas de água mineral, bambolês, bastões, bolas de plástico e cadeiras. RESULTADOS: As falas informais dos participantes referem melhora da fraqueza muscular nos membros superiores e inferiores, pois conseguem realizar atividades da vida diária (AVDs), que não conseguiam mais executar como subir escadas, alcançar objetos guardados em lugares altos. Há relatos de melhora nas relações pessoais, redução de sentimento de tristeza e depressão, entendimento dos integrantes do grupo quanto a importância da atividade física na melhora na execução e no desempenho das atividades de vida diária

Atividade física como instrumento de educação popular em saúde

OBJETIVO: Mostrar a atividade física em grupo como instrumento de Educação Popular em Saúde. MÉTODOS: Relato de experiência de atividade física coletiva em idosos como instrumento de Educação Popular em Saúde. Acontece na Unidade de Saúde Dr. Antônio Benício Freire da Silva. O projeto de flexibilidade e exercícios funcionais iniciou em 2014. Acontece duas vezes por semana, com duração de uma hora, com uma média de 18 participantes. As sessões seguem um roteiro predefinido com aquecimento, exercícios Funcionais e de Força e finaliza com a volta calma. Os materiais utilizados são garrafinhas de água mineral, bambolês, bastões, bolas de plástico e cadeiras. RESULTADOS: As falas informais dos participantes referem melhora da fraqueza muscular nos membros superiores e inferiores, pois conseguem realizar atividades da vida diária (AVDs), que não conseguiam mais executar como subir escadas, alcançar objetos guardados em lugares altos. Há relatos de melhora nas relações pessoais, redução de sentimento de tristeza e depressão, entendimento dos integrantes do grupo quanto a importância da atividade física na melhora na execução e no desempenho das atividades de vida diária

Unidade básica educadora popular em saúde

Objetivo: Relatar a experiência dos profissionais da Estratégia Saúde da Família de uma Unidade Básica de Saúde em sua formação de Educadores Populares em Saúde. Método: A experiência começou na reunião em equipe quando decidimos matricular as enfermeiras, os agentes comunitários de saúde, as técnicas de enfermagem, a psicóloga do NASF e uma das dentistas da Unidade Básica de Saúde do Poti Velho no curso de Educação Popular em Saúde (EPS) que estava sendo oferecido pela FIOCRUZ em parceria com a Universidade Federal do Piauí. Em fevereiro de 2014, 15 profissionais da ESF do Poti velho assistiram o curso de formação em educadores populares em saúde, durante uma semana às aulas aconteceram no horário diurno, em seguida acompanhamos o curso através do ambiente virtual de aprendizagem (AVA), desenvolvendo trabalhos com as comunidades assistidas pelas equipes capacitadas e postando-os no AVA, como forma de demonstrar e compartilhar o que aprendemos durante o curso.  Resultados: incorporação de uma nova forma de trabalhar educação em saúde, valorizando o conhecimento da comunidade, trazendo os usuários para as reflexões propostas e a criação do núcleo de Educação Popular em Saúde

Pathogenesis, diagnosis and management of pneumorrhachis

Pneumorrhachis (PR), the presence of intraspinal air, is an exceptional but eminent radiographic finding, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. By reviewing the literature and analysing a personal case of traumatic cervical PR after head injury, we present current data regarding the pathoanatomy, clinical and radiological presentation, diagnosis and differential diagnosis and treatment modalities of patients with PR and associated pathologies to highlight this uncommon phenomenon and outline aetiology-based guidelines for the practical management of PR. Air within the spinal canal can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and nontraumatic PR. Intraspinal air is usually found isolated not only in the cervical, thoracic and, less frequently, the lumbosacral regions but can also be located in the entire spinal canal. PR is almost exceptional associated with further air distributions in the body. The pathogenesis and aetiologies of PR are multifold and can be a diagnostic challenge. The diagnostic procedure should include spinal CT, the imaging tool of choice. PR has to be differentiated from free intraspinal gas collections and the coexistence of air and gas within the spinal canal has to be considered differential diagnostically. PR usually represents an asymptomatic epiphenomenon but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of PR has to be individualized and frequently requires a multidisciplinary regime

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

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

Guiding design of dementia friendly environments in residential care settings: Considering the living experiences

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Learning through VR gaming with virtual pink dolphins for children with ASD

Autism Spectrum Disorder (ASD) is a developmental disorder with different levels of severity. Although the exact causes of ASD is not yet known, nor is there a medical cure for ASD to date, special facilities and schools have been established to help individuals coping better and becoming more independent. With the advancement in Virtual Reality (VR) technology, there has been a greater depth of development of technology-enhanced game-based learning for children with ASD. This paper will describe our effort on virtual pink dolphins to assist children with ASD in their learning, at the same time, to avoid the use of physical pink dolphins which is a species endangered. A study on the use of a low-cost VR enabled pink dolphins game for children with ASD to learn direction following, psychomotor skills and hand-eye coordination will be reported.NRF (Natl Research Foundation, S’pore)Accepted versio