Remote intensive management to improve antiplatelet adherence in acute myocardial infarction: a secondary analysis of the randomized controlled IMMACULATE trial.

This study aim to investigate if remote intensive coaching for the first 6 months post-AMI will improve adherence to the twice-a-day antiplatelet medication, ticagrelor. Between July 8, 2015, to March 29, 2019, AMI patients were randomly assigned to remote intensive management (RIM) or standard care (SC). RIM participants underwent 6 months of weekly then two-weekly consultations to review medication side effects and medication adherence coaching by a centralized nurse practitioner team, whereas SC participants received usual cardiologist face-to-face consultations. Adherence to ticagrelor were determined using pill counting and serial platelet reactivity measurements for 12 months. A total of 149 (49.5%) of participants were randomized to RIM and 152 (50.5%) to SC. Adherence to ticagrelor was similar between RIM and SC group at 1 month (94.4 ± 0.7% vs. 93.6±14.7%, p = 0.537), 6 months (91.0±14.6% vs. 90.6±14.8%, p = 0.832) and 12 months (87.4±17.0% vs. 89.8±12.5%, p = 0.688). There was also no significant difference in platelet reactivity between the RIM and SC groups at 1 month (251AU*min [212-328] vs. 267AU*min [208-351], p = 0.399), 6 months (239AU*min [165-308] vs. 235AU*min [171-346], p = 0.610) and 12 months (249AU*min [177-432] vs. 259AU*min [182-360], p = 0.678). Sensitivity analysis did not demonstrate any association of ticagrelor adherence with bleeding events and major adverse cardiovascular events. RIM, comprising 6 months of intensive coaching by nurse practitioners, did not improve adherence to the twice-a-day medication ticagrelor compared with SC among patients with AMI. A gradual decline in ticagrelor adherence over 12 months was observed despite 6 months of intensive coaching.

Analysis of the effectiveness of remote intervention of patients affected by chronic diseases: A systematic review and meta-analysis.

Objectives: The aim of the study was to verify the effectiveness of telemedicine in randomized controlled trials (RCTs) in terms of its influence on physical conditioning, quality of life, and health conditions in adults/elderly people affected by chronic diseases. Design: This was a systematic review and meta-analysis. Methods: The search covered RCTs published from 2011 to 2021 and was conducted using the PubMed, Embase, PEDro, Lilacs, and Cochrane Library databases, on volunteers of both sexes, that were rehabilitated, and/or monitored, and/or evaluated, specifically, via remote care. The extraction, quality of studies, and risk of bias were assessed using the RoB2 (risk of bias) tool, for analysis of the strength of evidence, the GRADE (Grading of Recommendations Assessment, Developing, and Evaluation) method was used, and for the preparation of meta-analysis was used at RevMan 5.4 (Review Manager) was used. Results: The database search identified 3949 potential articles for screening, 13 of which were eligible for the present systematic review, involving 1469 participants with chronic diseases (chronic obstructive pulmonary disease (COPD), asthma, heart failure, diabetes mellitus, and fibromyalgia). Through the meta-analysis, an advantage was identified for the remote intervention on physical conditioning (p = 0.001), with an estimated effect of 0.29 (0.11, 0.46) and on health conditions (p = 0.0004), -0.30 (-0.47, -0.14), while for quality of life, no significant difference was identified (p = 0.90), 0.01 (-0.13, 0.14). Conclusion: Telemedicine has clinical effectiveness for the outcome of physical conditioning and general health conditions in adults with chronic diseases when compared to usual care without face-to-face intervention.

Effect of kinesio-taping on the acute phase of the post-operative reconstruction of the anterior cruciate ligament: A randomized controlled trial.

OBJECTIVES: Evaluate the Kinesio taping (KT) effects on reducing pain and edema on postoperative (PO) after anterior cruciate ligament (ACL) reconstruction. DESIGN: Controlled and randomized clinical study. SETTINGS: Individuals of both sexes, aged 18-45, underwent ACL reconstruction were randomized into intervention (IG; n = 19) and control (CG; n = 19) groups. METHODS: Intervention consisted of KT bandage applications at hospital discharge for seven days, and on the 7th PO day, which was removed on the 14th PO. CG received specific instructions from the physiotherapy service. All volunteers were evaluations before and immediately after surgery, on the 7th and 14th PO day. Pain threshold (KgF), evaluated by algometer; edema (cm), evaluated by the perimetry measurements and volume of the lower limbs and the truncated cone test (ml) were the evaluated variables. The Student's t-test and Mann-Whitney U test were used to evaluate intergroup, analysis of variance (ANOVA) and Dunnett's test to evaluate intragroup. RESULTS: Edema reduction and increased nociceptive threshold were significant in the 7th (p < 0.001; p = 0.003) and 14th (p < 0.001; p = 0.006) PO day in IG when compared to CG patients. IG perimetry levels, on the 7th and 14th PO were similar to preoperative period (p = 0.229; p = 1.000). IG nociceptive threshold value was similar on the 14th PO to before the surgery (p = 0.987). The same pattern did not occur in CG. CONCLUSION: KT treatment reduced edema and increased nociceptive threshold in the 7th and 14th PO ACL reconstruction.

To sanitize is to eugenize: the "preventive" eugenics of Belisário Penna at the service of sanitation in Brazil, 1920-1930. / Sanear é eugenizar: a eugenia "preventiva" de Belisário Penna a serviço do saneamento do Brasil, 1920-1930.

The purpose of this article is to discuss the eugenics model used by the medical-sanitarist Belisário Penna during the sanitation campaign in Brazil in the 1920s and 1930s. The article addresses two fundamental concepts for his thinking: "Brazilian race" and "preventive" eugenics. The way in which Penna saw the Brazilian racial issue was fundamental to adhere to the eugenic conception combined with social medicine and its project of "health awareness." The text offers a perspective of how Penna's eugenics was conceived and the dialogue established with the Brazilian eugenic movement, especially with the eugenicist Renato Kehl. Thus, the defense of an eugenics classified as "preventive" established a coherence for a social reform project through the sanitation defended by Penna.

Discute o modelo de eugenia empregado pelo médico-sanitarista Belisário Penna durante a campanha do saneamento do Brasil nas décadas de 1920 e 1930. São abordados dois conceitos fundamentais para o seu pensamento: "raça brasileira" e eugenia "preventiva". A maneira como Penna avaliava a questão racial brasileira era fundamental para aderir à concepção eugênica aliada à medicina social e ao seu projeto de "consciência sanitária". O texto oferece uma perspectiva de como foi bordada a concepção eugênica de Penna e o diálogo estabelecido com o movimento eugênico brasileiro, em especial com o eugenista Renato Kehl. Assim, a defesa de uma eugenia classificada como "preventiva" estabelecia coerência para um projeto reformista social via o saneamento defendido por Penna.

Effects of low-power laser auriculotherapy on chronic spinal pain: Randomized clinical trial.

AIMS AND OBJECTIVES: To evaluate the effect of laser auriculotherapy on chronic spinal pain. It is a randomized controlled clinical trial. METHODS: Volunteers with chronic spinal pain underwent three evaluations: an initial evaluation, a final evaluation immediately after the last intervention session, and a 15-day follow-up. Pain intensity, nociceptive threshold in relation to mechanical stimulus, and degree of pain (the greatest and least pain) in the last seven days were the assessed variables. The experimental group (EG, n = 24) underwent 10 sessions of laser auriculotherapy twice a week, while the control group (CG, n = 23) did not receive any intervention. RESULTS: The EG showed great clinical improvement in relation to the variable pain intensity between pre- and post-interventions (65.2%) and pre-intervention and follow-up (58.62%) compared to the CG. There was a significant increase in the nociceptive threshold for the EG. In contrast, the CG showed a significant reduction in the nociceptive threshold. The intergroup analysis indicated an improvement in pain intensity for the EG (0.006). This result remained at the follow-up (0.012). The nociceptive threshold increased over time for the EG (0.016). In contrast, the CG showed a reduction in this variable with a significant difference over time (<0.001). CONCLUSION: The results of this clinical trial suggest that the proposed intervention may be effective in reducing pain intensity and increasing the nociceptive threshold. The effect of the intervention remained 15 days after the end of the treatment, when the volunteers were re-evaluated.

On one of the smallest Amazonian scorpions: a new species of Microtityus (Scorpiones, Buthidae) from Brazil, with amended diagnosis and potential distribution analysis for the genus

A new scorpion species, Microtityus adriki n. sp., is described based on adult specimens collected in Cantá, state of Roraima (RR), northern Brazil. Microtityus adriki n. sp. is the second species of Microtityus Kjellesvig-Waering, 1966 known from Brazil and is one of the smallest scorpion species (12.39-19.47 mm) in the Amazonian region. In this study, we propose an amended generic diagnosis and a specific diagnosis, describe the male hemispermatophore of Microtityus, give the sequence of COI barcode, and present a potential distribution analysis for the genus. The morphology of the male hemispermatophore of Microtityus differs from that of other Neotropical buthid genera, except for the number of lobes (three lobes), which is a character state shared with several genera. The potential distribution model generated by MaxEnt suggests high environmental suitability for the genus in the Antilles and northern South America, with scattered high suitability in several regions of Central America. However, the model did not indicate high suitability in areas where Brazilian species occur (i.e., Microtityus adriki n. sp. and Microtityus vanzolinii Lourenço & Eickstedt, 1983), and this could be explained by a sampling bias. Therefore, future studies, including extensive sampling, are required to better understand the biogeographic processes behind the distribution of this genus.

Scorpions (Arachnida: Scorpiones) from the Serra de Piquiatuba, Santarém, Pará, northern Brazil

The Serra de Piquiatuba is situated in the area of the 8th Battalion of Engineering and Construction—8° BEC, located at km 8 of the Santarém–Cuiabá highway, in the municipality of Santarém, Pará, Brazil. This region is characterized by a hot and humid climate with rainfall exceeding 1900 mm p.a. In this study, we present a species list of scorpions from the Serra de Piquiatuba, based on data collected from September to November 2010. Five species were recorded, all common in the Amazon, belonging to the families Buthidae and Chactidae. The observed diversity patterns are discussed considering other scorpion inventories carried out in Brazil and possible sampling biases. The present study raises methodological questions to be further addressed in scorpion community ecology studies.

Sanear é eugenizar: a eugenia "preventiva" de Belisário Penna a serviço do saneamento do Brasil, 1920-1930 / To sanitize is to eugenize: the "preventive" eugenics of Belisário Penna at the service of sanitation in Brazil, 1920-1930

Resumo Discute o modelo de eugenia empregado pelo médico-sanitarista Belisário Penna durante a campanha do saneamento do Brasil nas décadas de 1920 e 1930. São abordados dois conceitos fundamentais para o seu pensamento: "raça brasileira" e eugenia "preventiva". A maneira como Penna avaliava a questão racial brasileira era fundamental para aderir à concepção eugênica aliada à medicina social e ao seu projeto de "consciência sanitária". O texto oferece uma perspectiva de como foi bordada a concepção eugênica de Penna e o diálogo estabelecido com o movimento eugênico brasileiro, em especial com o eugenista Renato Kehl. Assim, a defesa de uma eugenia classificada como "preventiva" estabelecia coerência para um projeto reformista social via o saneamento defendido por Penna.

Abstract The purpose of this article is to discuss the eugenics model used by the medical-sanitarist Belisário Penna during the sanitation campaign in Brazil in the 1920s and 1930s. The article addresses two fundamental concepts for his thinking: "Brazilian race" and "preventive" eugenics. The way in which Penna saw the Brazilian racial issue was fundamental to adhere to the eugenic conception combined with social medicine and its project of "health awareness." The text offers a perspective of how Penna's eugenics was conceived and the dialogue established with the Brazilian eugenic movement, especially with the eugenicist Renato Kehl. Thus, the defense of an eugenics classified as "preventive" established a coherence for a social reform project through the sanitation defended by Penna.

Visão geral da Conjuntura / Visão Geral : Visão geral da Conjuntura

A economia brasileira vem se caracterizando por fortes contrastes desde setembro deste ano. Se por um lado a produção e as vendas mostraram reação surpreendente ao choque adverso inicial causado pela pandemia, de modo que a queda do PIB em 2020, que projetamos em 4,3%, será bem menor do que a prevista pela maior parte dos analistas em meados do ano, por outro se observa uma recuperação desigual entre setores, com a indústria e o comércio em níveis médios acima do período pré-crise e os serviços ainda significativamente abaixo. No mercado de trabalho, os efeitos da recuperação, apesar de visíveis, ainda são modestos, e a perspectiva é que a taxa de desemprego ainda aumente antes de começar a cair ­ devido ao provável aumento da procura por trabalho em 2021. Nos mercados financeiros, muito em função das expectativas, houve fortes oscilações nos juros, na taxa de câmbio e na bolsa de valores, embora com tendência favorável nas últimas semanas. Subjacentes a esses movimentos estão fatores ligados à evolução da própria pandemia, no Brasil e no exterior; ao comportamento da economia mundial e à perspectiva da política econômica nos países avançados; e, principalmente, à política fiscal brasileira. Embora o grau de incerteza ainda se mantenha elevado, supondo que a consolidação fiscal será retomada após esse período de elevados gastos extraordinários em função da emergência de saúde pública, projetamos um crescimento de 4,0% em 2021.

Checklist dos escorpiões (Arachnida, Scorpiones) do Mato Grosso do Sul, Brasil / Checklist of the scorpions (Arachnida, Scorpiones) from Mato Grosso do Sul State, Brazil

Nesse artigo é fornecida uma lista de espécies de Scorpiones do estado do Mato Grosso do Sul, Brasil. Até o momento 16 espécies e uma subespécie não-nominotípica estão registradas para o estado, porém é discutida a presença e/ou o status taxonômico de três destas espécies. Assim, considera-se que a escorpiofauna do Mato Grosso do Sul é composta, até o momento, por 13 espécies, o que representa mais de 50% de todas as espécies de escorpiões conhecidas para o Centro-Oeste brasileiro. Duas espécies de bothriurídeos são conhecidas apenas para este estado e consideradas endêmicas Bothriurus pora Mattoni & Acosta, 2005 e Brazilobothriurus pantanalensis Lourenço & Monod, 2000. A distribuição dos registros de escorpiões no Mato Grosso do Sul é heterogênea, uma vez que as áreas dominadas por Mata Atlântica e pelo Pantanal são menos amostradas em relação àquelas de domínios do Cerrado.

In this paper it is provided a checklist of Scorpiones species in the state of Mato Grosso do Sul, Brazil. There are 16 species and one non-nominotypical subspecies recorded for the state, although it is discussed the presence and/or the taxonomic status of three of these species. This, it is considered that the scorpiofauna of the Mato Grosso do Sul is actually composed of 13 species, which represents more than 50% of all known species from Central-western Brazil. Two bothriurid species are known only for this state and are considered endemics: Bothriurus pora Mattoni & Acosta, 2005 and Brazilobothriurus pantanalensis Lourenço & Monod, 2000. The distribution of the scorpion registries in the Mato Grosso do Sul is heterogeneous, being the areas dominated by Atlantic Forest and Pantanal is sampled worse than those covered by the Cerrado domains.

Two new species of Bothriurus Peters, 1861 (Scorpiones, Bothriuridae) from Northeastern Brazil

Two new species of Bothriurid scorpions, Bothriurus delmari n. sp. and B. aguardente n. sp., are described from Bahia, Northeastern Brazil. These species are included in the asper group owing to the peculiar hemispermatophore morphology. These two newly described species increases to 47 the number of known and valid Bothriurus species. Additionaly, the known distribution of Bothriurus asper is updated.

Foot reflexology in feet impairment of people with type 2 diabetes mellitus: randomized trial / Reflexologia podal no comprometimento dos pés de pessoas com diabetes mellitus tipo 2: ensaio randomizado / Reflexología podal en el comprometimiento de los pies de personas con diabetes mellitus tipo 2: ensayo aleatorio

AbstractObjective: to evaluate the effect of foot reflexology on feet impairment of people with type 2 diabetes mellitus.Method: this is a randomized, controlled and blind clinical trial. The sample was comprised by people with type 2 diabetes mellitus who, after being randomized into Treated group (n = 21) and Control group (n = 24), received guidelines on foot self-care. To the Treated Group it was also provided 12 sessions of foot reflexology. The scores of impairment indicators related to skin and hair, blood circulation, tissue sensitivity and temperature were measured by means of the instrument for assessing tissue integrity of the feet of people with diabetes mellitus. Chi-square test, Fisher exact test, Mann-Whitney test and regression analyzes were applied to the data, considering a significance level of 5% (P value <0.05).Results: participants who received the therapy showed better scores in some impairment indicators related to skin and hair (hair growth, elasticity/turgor, hydration, perspiration, texture and integrity of the skin/ skin peeling).Conclusion: the foot reflexology had a beneficial effect on feet impairment of people with type 2 diabetes mellitus, which makes it a viable therapy, deserving investment. This study was registered in the Brazilian Registry of Clinical Trials - RBR-8zk8sz.

ResumoObjetivo:avaliar o efeito da reflexologia podal no comprometimento dos pés de pessoas com diabetes mellitus tipo 2.Método:trata-se de um ensaio clínico, randomizado, controlado e mascarado. A amostra foi composta por pessoas com diabetes mellitus tipo 2 que, após serem randomizadas em grupo Tratado (n=21) e Controle (n=24), receberam orientações de autocuidado com os pés. Ao Grupo Tratado também foram fornecidas 12 sessões de reflexologia podal. Foram mensurados os escores de comprometimento de indicadores relacionados à pele e pelos, circulação sanguínea, sensibilidade e temperatura tissular por meio do Instrumento para avaliação da integridade tissular dos pés de pessoas com diabetes mellitus. Aos dados foram aplicados os testes Qui-Quadrado, Exato de Fisher, Mann-Whitney e Análises de regressão, considerando-se nível de significância de 5% (Valor P<0,05).Resultados:os participantes que receberam a terapia apresentaram melhores escores de comprometimento em alguns indicadores relacionados à pele e pelos (crescimento de pelos, elasticidade/tugor, hidratação, transpiração, textura e integridade da pele/descamação cutânea).Conclusão:a reflexologia podal apresentou efeito benéfico sobre o comprometimento dos pés de pessoas com diabetes mellitus tipo 2, o que a torna uma terapia viável e que merece investimento. Este estudo foi registrado no Registro Brasileiro de Ensaios Clínicos - RBR-8zk8sz.

ResumenObjetivo:evaluar el efecto de la reflexología podal en el comprometimiento de los pies de personas con diabetes mellitus tipo 2.Método:se trata de un ensayo clínico, aleatorio, controlado y enmascarado. La muestra estuvo compuesta por personas con diabetes mellitus tipo 2 que, después de ser tratadas aleatoriamente en los grupos Tratado (n=21) y Control (n=24), recibieron orientaciones de autocuidado de los pies. También, al Grupo Tratado se le suministraron 12 sesiones de reflexología podal. Fueron medidos los puntajes de comprometimiento de indicadores relacionados a la piel y pelos, circulación sanguínea, sensibilidad y temperatura tisular por medio de instrumento para evaluación de la integridad del tejido de los pies de personas con diabetes mellitus. Los datos fueron sometidos a las pruebas Chi-cuadrado, Exacta de Fisher, Mann-Whitney y Análisis de regresión, considerando un nivel de significación de 5% (Valor p<0,05).Resultados:los participantes que recibieron la terapia presentaron mejores puntajes de comprometimiento en algunos indicadores relacionados a la piel y pelos (crecimiento de pelos, elasticidad/turgencia, hidratación, transpiración, textura e integridad de la piel/descamación cutánea).Conclusión:la reflexología podal presentó efecto benéfico sobre el comprometimiento de los pies de personas con diabetes mellitus tipo 2, lo que la torna una terapia viable y que merece inversiones. Este estudio fue registrado en el Registro Brasileño de Ensayos Clínicos - RBR-8zk8sz.

Ansiedade e espiritualidade em estudantes universitários: um estudo transversal / Ansiedad y espiritualidad en estudiantes universitarios: un estudio transversal / Anxiety and spirituality in university students: a cross-sectional study

RESUMOObjetivo:investigar a ansiedade e a espiritualidade de estudantes universitários e a relação entre elas.Método:para a coleta de dados, foi utilizado o Inventário de ansiedade traço-estado (IDATE) e a Escala de Espiritualidade de Pinto e Pais-Ribeiro.Resultados:participaram 609 alunos, sendo que 91,5% apresentam níveis moderados e altos de ansiedade-traço; 92,9%, os mesmos níveis de ansiedade-estado e 93,8% alto escore de espiritualidade. O teste de regressão linear múltipla apontou relação signifi cativa entre a ansiedade e a presença de desconfortos físicos, de movimentos pouco comuns e necessidade de tratamento. Os maiores níveis de ansiedade estiveram associados ao sexo feminino, à ausência de atividades de lazer e aos baixos níveis de otimismo da escala de espiritualidade.Conclusão:é importante o desenvolvimento de estratégias de enfrentamento da ansiedade que, por sua vez, podem estar voltadas a fatores protetores, como a espiritualidade.

RESUMENObjetivo:identificar la ansiedad y espiritualidad de los estudiantes universitarios, y investigar la relación entre ellas.Método:para la colección de datos se utilizó el Inventario de Ansiedad Estado-Trazo y la escala de espiritualidad de Pinto y Pais-Ribeiro.Resultados:participaron del estudio 609 estudiantes y 91,5% tienen niveles moderados y altos de ansiedad trazo y estado de ansiedad del 92,9%, y 93,8% tenía una puntuación alta de la espiritualidad. La prueba de regresión lineal múltiple indica una relación signifi cativa entre la ansiedad y la presencia de molestias físicas, movimientos inusuales y de la necesidad de llevar a cabo el tratamiento. Sin embargo, los niveles más altos de ansiedad se asociaron con el sexo femenino, la falta de práctica de láser y los niveles bajos de la escala dimensión optimismo de la espiritualidad.Conclusión:es importante desarrollar estrategias para hacer frente a la ansiedad que a su vez pueden estar orientados hacia los factores de protección, como la espiritualidad.

ABSTRACTObjective:to study anxiety and spirituality and the relationship between them in university students.Method:the State-Trait-Anxiety Inventory (STAI) and Pinto and Pais-Ribeiro Spirituality Scales were used for data collection.Results:six hundred and sixty-nine students participated in the study, of whom 91.5% had moderate and high levels of trait anxiety and 92.9% of state anxiety; 93.8% had high spirituality scores. The multiple linear regression test showed a signifi cant relationship between anxiety and the presence of physical discomfort, unusual body movements, and the need for treatment. Furthermore, higher levels of anxiety were associated with the female gender, the lack of leisure activities, and low levels of optimism in the spirituality scale.Conclusion:it is important to develop strategies for coping with anxiety, which in turn can be oriented toward protective factors such as spirituality.

Presença de ovos de helmintos em hortaliças fertilizadas com lodo de lagoa de estabilizaçäo / Presence of the helminths eggs in vegetables fertilized with stabilization lake sludge

Foi verificada a presença de ovos de helmintos parasitas, tais como Ancilostomídeos, Ascaris lumbricoides, Trichuris sp e Enterobius vermicularis, em hortaliças fertilizadas com lodo de esgoto da Estaçäo de Tratamento Coletivo de Esgoto da Lagoa de Estabilizaçäo situada em Sertäo do Carangola, no município de Petrópolis, RJ, Brasil.